Are head and neck specific quality of life measures necessary?

BACKGROUND: The purpose of this study was to determine whether head and neck-specific health status domains are distinct from those assessed by general measures of quality-of-life (QOL). METHODS: Cross-sectional study of 55 head and neck cancer patients in tertiary academic center was made. Three head and neck-specific measures,-including the Head & Neck Survey (H&NS); a brief, multi-item test which generates domain scores; and a general health measure,-were administered. RESULTS: The H&NS was highly reliable and more strongly correlated to the specific measures than to the general measure. Eating/swallowing (ES) and speech/communication (SC) were not well correlated with general health domains. Head and neck pain was highly correlated to general bodily pain (0.88, p < .0001). Despite correlations to some general health domains, appearance (AP) was not fully reflected by any other domain. CONCLUSIONS: Head and neck-specific QOL measures are necessary and should include domains that reflect ES, SC, and AP.     

Calls on reproductive and developmental toxicants to a regional poison center

OBJECTIVES/HYPOTHESIS: Rehabilitation following head and neck cancer surgery has steadily moved into the outpatient realm and become dependent on caregivers with no formal medical background (lay caregivers.) Satisfactory rehabilitation and quality of life (QOL) depend on successful relationships between patients and the lay caregivers. This study evaluates the QOL assessments of patients by themselves and their primary lay caregivers before head and neck surgery. STUDY DESIGN: Institutional Review Board-approved study using validated QOL assessment instrument. MATERIALS AND METHODS: The preoperative QOL status in 50 patients undergoing extensive head and neck surgery was evaluated using the self-administered Medical Outcomes Survey Short Form 36 (SF-36). The patient's primary lay caregiver (spouse, child, or friend) completed a similar questionnaire evaluating the patient's status. RESULTS: Thirty-three (66%) questionnaires were returned. Twenty-five (50%) questionnaire sets were successfully completed by both parties and employable for comparison. Sixty percent of the caregivers were within the 90% confidence interval of the patient's assessment for six or more of the eight parameters evaluated by the SF-36. Likewise, caregiver assessments for specific parameters were consistently congruent with patient evaluation, except for the parameters of bodily pain and general health, for which caregivers demonstrated a trend for overrating pain and underestimating general health. Caregivers of the same generation as the patient demonstrated significantly higher congruence (P = .007). Similarly, a trend for higher congruence was noted in patients with recurrent disease. CONCLUSIONS: The importance of the lay caregiver has increased in the era of greater outpatient rehabilitation. This pilot study indicates that QOL assessment by lay caregivers may be examined with existing instruments and highlights QOL parameters critical to both the head and neck surgery patient and his or her primary lay caregiver.     

Hyperfractionated radiotherapy and simultaneous cisplatin for stage-III and -IV carcinomas of the head and neck. Long-term results including functional outcome

PURPOSE: To assess the survival rate, the probability of local control, the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy (RT) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck. METHODS: From 1988 to 1994, 64 patients (median age 55.5 years) with carcinomas of different subsites, excluding the nasopharynx, were treated in a pilot study with 1.2 Gy bid (6 h interval; total dose 74.4 Gy) and simultaneous CDDP (20 mg/m2 daily, 5 days in week 1 and 5) and followed at regular intervals. Overall survival and local control, as well as the rates of late toxicity, were estimated using the actuarial method. Median follow-up was 3.3 years for all and 5.2 years for surviving patients. To assess the quality of life, the EORTC QLQ-C 30 questionnaire and the H&N35 module questionnaire were sent to the patients surviving with no evidence of disease or second primary tumors; they were answered by 15/23 (67%). RESULTS: Overall survival was 37% at 5 years, whereas disease-specific survival was 59%. Twenty-three patients died from uncontrolled head and neck cancer. Second primary tumors were observed in 13 patients, most frequently in the lung. Local control without salvage surgery was 74% at 5 years for all subsites and stages, and loco-regional disease-free survival was 72%. Eleven patients developed distant metastases, which was the only site of failure in 6 cases. Salvage surgery was successful in 2 cases. The actuarial estimates of > or = grade-3 late toxicity was 4% for the mandibular bone and 23% for dysphagia, and 50% of the patients experienced a permanent xerostomy. Self-reported global quality of life in surviving patients was good (mean 68 points on a scale 0 to 100); consequences of impaired salivary function had most impact on nutritional and social aspects. CONCLUSIONS: Hyperfractionated RT with concomitant CDDP is well tolerated and highly efficient in controlling moderately advanced to advanced cancers of the head and neck. Second primary tumors are the main cause of death after 3 years and were observed outside of the irradiated area, most frequently in the lung. Even after RT of large volumes to a high dose, salvage surgery can be successfully performed in individual cases. Self-reported quality of life of surviving patients is good, despite xerostomy-associated nutritional difficulties.     

The Head and Neck Radiotherapy Questionnaire: a morbidity/quality-of-life instrument for clinical trials of radiation therapy in locally advanced head and neck cancer

PURPOSE: The purpose of this study was to develop and validate an instrument for clinical trials to measure radiation-related acute morbidity and quality of life from the perspective of patients with head and neck cancer (HNC) treated with radiotherapy. METHODS: The Head and Neck Radiotherapy Questionnaire (HNRQ) was developed by a panel of health care workers and patients, was pretested in a pilot study of HNC patients, and was validated in a randomized double-blind trial of concomitant fluorouracil (FUra) infusional therapy (1.2 g/m2 per 24 hours) or saline placebo administered for 72 hours in the first and third weeks of a 6 1/2-week course of radiation therapy. The HNRQ was validated against existing toxicity and performance status indices, all of which were measured weekly for the 6 1/2 weeks of treatment and for 4 weeks posttreatment. RESULTS: There were three a priori constructs: (1) that the HNRQ scores would conform to a shallow U-shaped pattern to reflect declining quality of life (increasing morbidity) during radiation and recovery posttreatment; (2) that the HNRQ would correlate with existing toxicity indices (World Health Organization [WHO] stomatitis, Byfield stomatitis, WHO skin toxicity, Eastern Cooperative Oncology Group [ECOG] and Karnofsky performance status); and (3) that the HNRQ would discriminate between FUra and placebo groups. The HNRQ and its domain scores all showed a change from baseline reflecting increased morbidity during radiation (analysis of variance [ANOVA], P < .00001). The HNRQ correlated well with all other indices (r > or = .60), and domain scores correlated best with other indices that assess the same symptom complex (eg, HNRQ skin domain and WHO skin toxicity index, r = .77). There was a significant difference in HNRQ scores between the FUra and placebo groups during radiation (ANOVA, P = .0007), and all HNRQ domains also discriminated between the treatment groups. CONCLUSION: The HNRQ is a valid measure of acute morbidity due to radiation therapy in patients with locally advanced HNC, and may be useful as an outcome measure for future clinical trials of radiation treatment strategies.     

A new assessment of quality of life (QOL) for cancer patients

A new assessment of quality of life (QOL) was made for cancer patients. The QOL assessment consists of 12 items: pain; nausea; constipation; general fatigue; sleep; eating; activity; a daily life pattern; conversation; treatment acceptability; satisfaction at the present status and family exhaustion. Ranges of scores are one (best) to five (worst). For visual expression of QOL, the author made an original method called "QOL diagram", drawn with a circle which has 12 diverging lines marked five points indicating the score for each item. QOL changes after cancer pain control with either oral or intravenous morphine were examined in 22 adult cancer patients by the QOL assessment. Laxatives and anti-nausea drugs were mostly prescribed at the same time in order to avoid side effects of morphine. QOL was evaluated and recorded by the author through an individual interview with each patient. It was observed that the psychological factors were improved along with pain relief. Although items such as general fatigue, nausea, constipation, sleep and eating did not change considerably at first, they improved well with time in the oral morphine group. On the other hand, there was no marked time-dependent change in the intravenous morphine group. Items such as activity, a daily life pattern and conversation were rather negative than positive. These items seem to be more important to improve QOL of the cancer patients, in particular, whose general status is relatively good. In conclusion, the QOL diagram helped us to follow subtle changes of status and needs of cancer patients. And it enables us to easily assess risks and benefits of the treatment plans including palliative care and home supportive programs. It is designed for both patients and medical staffs to use easily and repeatedly. However, the further evaluation and refinement will be needed to verify validity and reliability of the QOL diagram before a routine clinical application.     

What''s new in surgery of flexor tendons?]

BACKGROUND: Visual acuity and vision related quality of life outcomes in cataract surgery were evaluated in a population based survey in two geographic zones in Nepal. METHODS: Case finding was based on random sampling using a stratified cluster design with door to door enumeration of people aged > or = 45 years followed by eye examinations at village sites. All aphakics/pseudophakics, those with visual acuity less than 6/60 in either eye, and a sample of those with normal visual acuity were administered visual functioning (VF) and quality of life (QOL) questionnaires. RESULTS: 15% of the 159 cataract operated cases had presenting visual acuity > or = 6/18 in both eyes, 38% with best corrected visual acuity. 21% were still blind with presenting visual acuity < 6/60 in both eyes, 7% with best correction. On a 0-100 scale, mean VF and QOL scores were 87.2 and 93.9 respectively in normally sighted unoperated individuals, dropping to 15.6 and 29.5 for those severely blind (< 3/60). Among the cataract operated, mean VF and QOL scores were 47.5 and 55.4, respectively. VF and QOL scores correlated with vision status at statistically significant levels (p < 0.0001). CONCLUSION: Cataract surgery outcomes, whether measured by traditional visual acuity or by patient reported VF/QOL, are at levels many would consider unacceptably low. It is apparent that in the quest to reduce cataract blindness much more attention must be given to improving surgery outcomes.     

Acupuncture worth trying in severe tinnitus

The article consists in a report of a study of 22 patients with disabling tinnitus, performed to elucidate the effects of a 3-month course of acupuncture (15 treatments) on the severity of tinnitus and on quality of life (QOL), as compared with those of individualised physiotherapy. The study was designed as a prospective, randomised, cross-over study with a follow-up period of one year after the final treatment. Treatment effects were evaluated in terms of the patients' VAS (visual analogue scale) ratings and answers to questionnaires, including the NHP (Nottingham Health Profile), regarding the impact of tinnitus on different aspects of QOL. Baseline NHP scores showed tinnitus patients to manifest pronounced depressive characteristics. Acupuncture was found to yield immediate relief, both in terms of loudness and disturbance of the tinnitus, and significant improvement in QOL (NHP) for three months after the conclusion of treatment. Although many patients in the subgroup with concurrent muscle tension reported beneficial effects of individualised physiotherapy, such treatment yielded no significant reduction of tinnitus loudness or disturbance due to tinnitus, and no improvement in NHP scores. In both treatment groups, however, both annoyance due to tinnitus and QOL scores had returned to pretreatment levels at one-year follow-up. Thus, the results suggest tinnitus patients to manifest depressive characteristics, and that acupuncture may yield temporary improvement in terms of tinnitus relief and QOL.     

Mechanical transport of rotavirus by the legs and wings of Musca domestica (Diptera: Muscidae)

BACKGROUND: Whether or not tumor response to chemotherapy-sensitized radiation therapy (CTRT) for head and neck cancer leads to an improved outcome is unknown. METHODS: Forty patients who received preoperative cisplatin plus simultaneous radiotherapy for operable stage III and IV head and neck cancer were reviewed retrospectively regarding clinical demographics, staging, and survival status. RESULTS: Twenty-one (57%) patients had a histologic complete response (HCR) and 16 (43%) had a partial (PR) (9) or clinical complete (7) response (CCR). Tumor response of N1 versus N2-3 nodal disease showed 6 (75%) HCR and 4 (25%). Five-year disease-free survival overall was 82% for HCR versus 38% for PR/CCR (P <0.05). Disease-specific 5-year survival was 100% for HCR versus 27% for PR/CCR (P <0.002). CONCLUSIONS: Histologic complete response to CTRT for head and neck cancer is associated with increased survival and encouraging disease-free status. Response to CTRT is inversely proportional to lymphatic tumor load.     

Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy

Quality of life (QOL) is an important consideration as patients survive longer with cancer and is an area of increasing interest in patients with thyroid cancer who undergo long-term cancer surveillance. However, there are few disease-specific QOL tools available to evaluate QOL in patients with thyroid cancer. The purposes of this longitudinal, repeated-measures study were to: (1) test a new instrument, the QOL-Thyroid Scale, during thyroid hormone withdrawal; and (2) to evaluate the impact of thyroid hormone withdrawal on patients' perceived changes in quality of life. The sample included 34 subjects (mean age 40 years) undergoing thyroid hormone withdrawal in preparation for scanning procedures. Subjects completed three instruments (demographic data tool, the QOL-Thyroid, and the FACT-G) at four specific time points in relationship to scanning. The results demonstrated that the QOL-Thyroid tool is a reliable and valid measure of QOL. Cronbach's alpha coefficient of r = .78 between QOL-Thyroid and FACT-G indicated good concurrent validity. Second, the impact of thyroid hormone withdrawal on QOL showed significant changes in physical, psychological, and social well-being across the four testing points. The greatest changes occurred between peak hormone withdrawal and thyroxine (T4) therapy. While it is generally known that patients suffer troublesome physical symptoms relating to thyroid hormone withdrawal, the negative psychological, family, and work sequelae are less apparent. In conclusion, the QOL-Thyroid is a reliable and valid measure for use in evaluating patients undergoing scanning procedures and may be used to identify and target teaching and support for high-risk areas in patients lives that are negatively affected by hormone withdrawal.     

Management of the N(0) neck

Paramount among the challenges and controversies among the head and neck surgeon is the proper treatment of the N0 neck. Therapeutic intervention for the N0 neck usually involves any of two treatment modalities alone or in combination: surgery or radiation therapy. This article discusses the potential treatment strategies for possible subclinical neck metastasis and the rationale for their use on a site by site basis for head and neck primary tumors.     

Quality of life after treatment in patients with laryngeal carcinoma]

Today laryngeal cancer can be cured by means of a variety of treatments (nearly 60% of the patients in an unselected population are still alive after 5 years). Despite the low incidence, this form of cancer can present a significant social problem because the form of treatment can have an impact on the esthetic, functional and emotional aspects affecting the quality of life (QOL). In the present study 690 laryngeal cancer patients treated with 6 different forms of therapy (total laryngectomy, partial laryngectomy, cordectomy, radiotherapy alone, total laryngectomy plus post-operative radiotherapy, partial laryngectomy plus post-operative radiotherapy) were asked to fill out a specific EORTC CORE QOL Questionnaire (EORTC QLQ C-30) as well as a specific head and neck questionnaire. Six multi-item function scales, 3 symptom scales and 6 individual items assessing both symptoms and economic consequences of the disease were evaluated. A total of 517 patients (74.92%) filled out the questionnaire. For each form of therapy the patients were divided by age (under and over 65 years of age). The results indicate that the quality of life is better in those patients who underwent a single form of treatment (i.e. radiotherapy alone, partial laryngectomy, total laryngectomy) than in those who underwent combination treatments (i.e. surgery plus radiotherapy). Moreover, the results were better in the older patients. Quite often laryngeal cancer patients are subject to psychosocial problems although this did not show up in the present study where the patients tended to consider surgery as a liberation. The social-cultural level of the patient has a significant effect on the quality of life as it proved better in those social classes were physical strength is of prime importance as opposed to those dominated by social parameters such as socialization, communication and aesthetics.     

What constitutes cerebral palsy?

OBJECTIVE: To determine whether a newly developed disability scale for patients with neck pain demonstrated acceptable reliability and validity. METHODS: Testing was conducted using three different samples of patients with neck pain (n = 162). Test-retest reliability of the scale was carried out on the same day with one sample (n = 39), and between-day reliability was carried out with another (n = 21). Differential item functioning with regard to the influence of gender and age was carried out with these two patient groups, as was construct validity. Responsiveness was measured using patients participating in a clinical trial involving patients with chronic neck pain (n = 102). Additionally, scale scores were compared with a wide range of physical measurements using the patients in the clinical trial. RESULTS: Short-term, between-day and postal questionnaire reliability coefficients were all extremely high. The Cronbach's alpha coefficient for internal consistency was 0.9 for the entire scale, and the coefficients for individual items were all greater than 0.88. Disability scale scores correlated strongly to pain scores as well as to doctor and patient global assessments, indicating good construct validity. Relative changes in disability scores demonstrated a moderately strong correlation to changes in pain scores after treatment. Scale scores correlated weakly to all physical measurements. CONCLUSIONS: The disability scale demonstrated excellent practicality and reliability. The scale accurately reflects patient perceptions regarding functional status and pain as well as doctor's global assessment and is responsive to change over long periods of time. We feel that this scale can be a valuable tool for the assessment of patients in future clinical trials and quality of care studies.     

Measuring health status in patients with skeletal metastases treated by surgery

Since the introduction of the Functional Living Index-Cancer (FLIC) > 10 years ago, a variety of general as well as disease-specific quality of life (QOL) instruments have been developed and used as a means of assessing the success of clinical interventions. Clinicians faced with selecting an appropriate QOL measurement tool will need guidance in both the selection of the instrument and its evaluation for applicability to the patient group under study. In our examination of this issue, we analyzed the results of administering the FLIC and the more general SF-36 questionnaire to a group of 17 patients who had undergone orthopaedic surgery to correct problems associated with bone metastatic cancer. Because the SF-36 has been widely adopted as a general Health Status evaluation tool and because of its extensive validation it may be considered a gold standard providing a means of assessing the validity of disease-specific instruments such as the FLIC. Using multivariate regression, we built a model in which five of the eight health status dimensions of the SF-36 account for 77% of the variation in the FLIC scores for this group of patients (R2 = 0.77). The implication of this result is that most of the information (i.e., 77%) provided by the FLIC could be equivalently obtained using the more general, more widely validated SF-36. Despite the small sample size, half of the regression coefficients in this model achieved a high level of statistical significance (p < 0.001). In addition, when applied to new patients, the model showed good predictive capability with relative error 2-20%. If these results can be replicated for other patient disease groups and in larger study populations, it may be possible to use the SF-36 as the primary QOL evaluation tool for cancer patients. The burden of this disease could then be more easily compared with that of other disease groups and the resulting standardization of QOL analysis would be simpler and more cost effective.     

The relationship among performance of instrumental activities of daily living, self-report of quality of life, and self-awareness of functional status in individuals with multiple sclerosis.

Objective: To investigate the relationship between self-awareness of functional status and performance of Instrumental Activities of Daily Living (IADL), and self-reports of quality of life (QOL) in persons with multiple sclerosis (MS). Design: A between-groups design, using a correlational approach to examine the relationship between self-awareness of functional status, IADL and QOL. Participants: We studied 47 individuals with clinically definite MS and 26 healthy controls (HCs). Measures: The Functional Behavior Profile was completed by both participants and their informants. Participants' scores were subtracted from those of their informants', and the absolute value was used as the self-awareness/concordance score. The Executive Function Performance Test measured IADL performance; QOL was measured with the Functional Assessment of Multiple Sclerosis. Results: MS participants showed lower levels of self-awareness relative to HCs. Significant correlations were observed between performance of IADL, reports of QOL and self-awareness levels of functional status. However, reports of QOL were not significantly correlated with performance of IADL. Conclusions: The positive association between self-awareness of functional status with IADL performance and QOL reports provides support for the role of awareness in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of bioactive functions in Hydrangeae Dulcis Folium. VII. Immunomodulatory activities of thunberginol A and related compounds on lymphocyte proliferation

PURPOSE: Vagus nerve stimulation (VNS) has been reported to produce >90% reduction in the number of seizures in children with intractable epilepsy. These encouraging results need confirmation. METHODS: Sixteen children, 10 boys and 6 girls aged 4-19 years, were treated with VNS (Cyberonics, Webster, TX, U.S.A.) for 12-24 months. Seizure frequency, seizure severity, changes in quality of life (QOL: visual analogue scale), and side effects were recorded. Eight children had partial and 8 had generalized seizures; 4 of the latter had Lennox-Gastaut syndrome (LGS). RESULTS: During the tenth to twelfth month of VNS, 6 of 16 children experienced > or =50% reduction in seizure frequency. One girl became seizure-free. Seizure severity showed an average decrease in the score from 15 to 11. After 10 months of treatment, QOL was estimated to have improved > or =50% in 6 of 16 children. Reduction in seizure frequency, decreased seizure severity, and reported improvement in QOL did not entirely coincide. Six children experienced hoarseness, 1 had neck pain, 2 had hypersalivation, 2 experienced tiredness, 2 had aspiration episodes during liquid intake, and 6 had electrical transmission problems; in 4 the problem has been surgically corrected. Five stimulators were turned off due to lack of efficacy. CONCLUSIONS: Six of 16 children with refractory epilepsy treated with VNS improved, with a reduction not only in seizure frequency but also in seizure severity and in QOL.     

Quality of life of patients with renal cell carcinoma or prostate cancer after radical surgery

OBJECTIVES: To study the impact of radical tumour surgery in prostate and renal cell cancer patients on quality of life (QOL). METHODS: In 38 male patients suffering from organ-confined prostate or renal cell cancer, a prospective study was performed. For the evaluation of QOL, we used the EMPK (Erfassung multipler psychischer Konstrukte). Urologic symptoms were evaluated with a specially designed symptom score. The test instrument was filled out the day before surgery and one year after operation. RESULTS: The EMPK was able to detect and describe significant changes in certain aspects of QOL in renal cell cancer and prostate cancer patients. Moreover, there seems to be a difference between the two groups. A direct relation between QOL and the different quality and quantity of operation-related symptoms, however, could not be proven. CONCLUSIONS: In this pilot study, radical surgical therapy did not significantly change QOL in prostate cancer patients, but seemed to have a positive influence on the QOL of renal cell cancer patients.     

Quality of life before and after liver transplantation for cholestatic liver disease

Liver transplantation (LT) is an established therapy for patients with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In this report, we describe the health status and quality of life (QOL) in patients with these cholestatic liver diseases before and after LT. A QOL questionnaire was completed by 157 adult patients with PBC or PSC before and 1 year after liver transplantation at the Mayo Clinic or Baylor University Medical Center. This questionnaire measured four aspects of QOL, including symptoms; physical, social, and emotional functioning; health perceptions; and overall QOL. Changes in these QOL parameters before and after LT were described, and regression analysis was used to assess the relationships between clinical and QOL factors. There were no differences in QOL parameters between patients with PBC and PSC. QOL following transplantation was substantially better than before transplantation. This was observed in all four aspects of QOL. The degree of improvement as measured by effect size (difference in mean scores divided by the pretransplantation standard deviation) was 0.53 for symptoms (P <.01), 1.16 for function (P <.01), 2.37 for health satisfaction (P <.01), and 1.16 for overall QOL (P <.01). Patients' overall QOL before transplantation was significantly related to subjective and objective health status indicators and clinical factors such as ascites and renal dysfunction. QOL at 1-year follow-up, however, could not be adequately predicted by the pretransplantation subjective health status and clinical factors. Patients with end-stage cholestatic disease undergoing LT experience substantial improvement in all aspects of QOL addressed in this study. The patients' QOL 1 year after LT could not be predicted by pretransplantation variables used in this study.     

Development and validation of the Pediatric Oncology Quality of Life Scale.

This study describes the development of a 21-item, parent report measure for assessing the quality of life (QOL) of children with cancer. The Pediatric Oncology Quality of Life Scale (POQOLS) provides a total score and three factor scores that assess physical function and role restriction, emotional distress, and reaction to current medical treatment. Internal consistency reliabilities of the total scale and the three factors were high, as was interparent agreement. In addition, POQOLS scores demonstrated good concurrent and discriminant relationships with scores on measures of adjustment hypothesized to covary with the dimensions of QOL assessed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency of Nd:YAG capsulotomy after implantation of PMMA and silicon intraocular lenses

From July 1, 1991, until January 1, 1993, a total of 7,720 patients (soldiers and civilians) with war wounds were treated at Dr. Josip Bencevi? General Hospital in Slavonski Brod, Croatia. Treatment was provided for 7,043 patients, whereas 677 individuals (8.8%) killed in action (KIA) were examined at the Forensic Department. There were 1,456 patients (18.9%) with head and neck wounds: 1,176 soldiers and 280 civilians. The mortality rate was significantly greater in patients with head and neck wounds (N = 271, 40.0%) than in those with injuries to the thorax (N = 163, 24.1%) and abdomen (N = 62, 9.2%; p < 0.01 for both). During treatment, 188 patients (2.4%) died of wounds (DOW). The DOW mortality was 5.2% (61 of 1,185), 4.0% (41 of 1,026), and 2.9% (25 of 867) for wounds of the head and neck, thorax, and abdomen, respectively. There was no significant difference in the mortality rate between head and neck and thorax wounds: however, the former exceeded the mortality rate recorded for abdominal wounds (p < 0.05). No significant differences were observed between soldiers and civilians with head and neck injuries either in the KIA (205 of 1,176, 17.4% vs. 66 of 280, 23.5%, respectively) or the DOW group (51 of 971, 5.3% vs. 10 of 214, 4.7%, respectively. According to the mechanism of head and neck wounding, there were 1,046 explosive (71.9%), 226 gunshot (15.5%), and 184 other (12.6%) wounds. Lethal outcome was significantly more common in gushot than in explosive wounds (79 of 226, 35% vs. 243 of 1,046, 23.2%; p < 0.01). The proportion of head and neck injuries did not differ significantly from literature reports on recent conventional wars. The site of wounding, i.e., at the battlefield or elsewhere, had no effect on the prognosis of wounds to the head and neck. Gunshot head and neck injuries showed a significantly higher mortality rate.     

The relationships between nasal hyperreactivity, quality of life, and nasal symptoms in patients with perennial allergic rhinitis

BACKGROUND: A clinical test that could inform the clinician about the severity of a patient's nasal symptoms and health-related quality of life (QOL) would be very useful. OBJECTIVE: We attempted to determine whether, in patients with perennial allergic rhinitis, nasal challenge with histamine could be used to estimate daily symptoms and QOL. METHODS: Forty-eight patients with perennial allergic rhinitis were challenged with histamine to determine nasal hyperreactivity. Nasal response was monitored by the number of sneezes, the amount of secretion, and a symptom score. Daily nasal symptoms were recorded during the 2 preceding weeks. Patients also completed a rhinitis QOL questionnaire. RESULTS: Responsiveness to histamine and total daily nasal symptoms were moderately correlated (r = 0.51, p = 0.001). Comparison of total daily nasal symptoms with the overall QOL score showed a moderate correlation (r = 0.59, p < 0.001). Nasal response to histamine and overall QOL score were also correlated (r = 0.43, p = 0.002). However, overall QOL and daily nasal symptoms could be predicted by wide 95% confidence intervals only for each decade of nasal responsiveness to histamine (expressed as a composite symptom score). CONCLUSION: In patients with perennial allergic rhinitis nasal hyperreactivity as determined by histamine challenge, QOL, and daily nasal symptoms are moderately correlated. Therefore nasal histamine challenge can be used as a tool for estimating the severity of daily nasal symptoms and QOL, although it cannot predict nasal symptoms and QOL very accurately.