Caring for patients with an ICD

The internal cardioverter defibrillator corrects life-threatening arrhythmias by providing antitachycardia pacing, pacing for bradycardia, and cardioversion or defibrillation shocks. However, there is little warning that the device may fire, which can cause physical, social and psychological problems for the patient. Nurses caring for ICD patients in the community and in hospital need to know what it is like to live with this device, how it works and the implications for other treatments.     

Caring for patients with HIV disease: the experience of a generic hospice

Following the recent realization that TCR beta transgenes can severely inhibit the rearrangement of endogenous Vbeta gene segments in the absence of pre-TCR alpha (pT alpha) chains, we tested whether the pre-TCR has an essential role in TCR beta allelic exclusion under more physiological conditions by analyzing TCR rearrangement in immature thymocytes by single-cell PCR. Our results in pT alpha+ mice are consistent with an ordered model of TCR beta rearrangement beginning on one allele and continuing on the other only when the first attempt is unsuccessful. By contrast, a higher proportion of thymocytes from pT alpha-/- mice exhibited two productive TCR beta alleles. Thus, the pre-TCR-independent suppression of rearrangement by TCR beta transgenes represents a transgene artifact, whereas under physiological conditions the pre-TCR is essential for allelic exclusion.     

Liver metastasis rare in colorectal cancer patients with fatty liver

BACKGROUND/AIMS: As no reports in terms of the relationship between fatty liver and liver metastasis of colorectal cancer clinicopathological analysis of colorectal cancer patients with fatty were found a liver was carried out. PATIENTS AND METHODS: Among 839 patients with single colorectal carcinoma who underwent operations at our department between 1985 and 1994, 121 patients were designated as fatty liver using ultrasonography (FL group). The remaining 718 non-fatty liver patients with colorectal cancer (NFL group) were compared to the FL group regarding clinicopathological aspects. RESULTS: (1) There were only two patients who had liver metastasis in the FL group (1.7%), while the NFL group included 115 patients with liver metastasis (16.0%) (p < 0.01). (2) The five-year survival rate of the FL group was 95.7%, which was significantly higher than that in the NFL group (9.8%) (p < 0.001). (3) In the multivariate analysis, the fatty liver was identified as an independent prognostic factor. CONCLUSIONS: The FL group had a much better prognosis compared to the NFL group. Especially, liver metastasis was extremely rare in the FL group. We believe that these results will lead to the clarification of the liver metastasis mechanism.     

Caring for the child with Down syndrome

This article reviews the etiology, treatment, and prognosis of Down syndrome. Effects of Down syndrome on growth and development, specific physiologic manifestations, and implications for school-based practice are discussed.     

Caring for AIDS patients at home--requirements for development of the concept

Exercise tolerance in chronic obstructive pulmonary disease (COPD) patients treated with oral aminophylline may be different from those treated with high-dose inhaled ipratropium bromide. The purpose of this study was to compare the effects of therapeutic doses of oral aminophylline with high-dose ipratropium bromide on spirometry and exercise tolerance. The study was conducted on three consecutive days in a double-blind, randomized, crossover fashion. Baseline studies obtained on each study day included vital signs, simple spirometry and a symptom-limited maximal cardiopulmonary stress test, after which patients received one of the following treatments on each day: Treatment 1, inhaled ipratropium (total dose of 144 micrograms) with placebo tablets; Treatment 2, inhaled placebo with oral aminophylline (400 mg); Treatment 3, inhaled placebo and placebo tablets. Simple spirometry was repeated at 60 and 120 min after baseline. Vital signs and cardiopulmonary stress testing was repeated at 120 min. Eighteen patients were enrolled in the study, and 17 of these completed the study. There was a significant (P < 0.05) increase in both forced expiratory volume in 1 s (FEV1), from 0.75 (0.21) to 0.92 (0.3), and forced vital capacity (FVC), from 1.8 (0.79) to 2.11 (0.84), with high-dose ipratropium despite prior beta-agonist therapy. Lack of improvement in exercise capacity was noted with ipratropium despite improvement in spirometry. These results suggest that elderly patients with severe COPD may have exercise limitation that is not directly dependent on severity of airflow obstruction. Ipratropium bromide and aminophylline demonstrated no acute effects on exercise capacity.     

Caring for caregivers

In home health nursing, the whole family is the client. In a recent issue of Home Care Provider, Knox and Thobaben discussed the need to identify the significant family members who influence health care resources and decisions. Whatever their relationship to the patient, these individuals frequently provide his or her primary care.     

Continuous intra-hepatic-arterial infusion of low dose 5-fluorouracil for colorectal cancer patients with unresectable liver metastases

Five cases of colorectal cancer with unresectable liver metastases treated from April 1992 to April 1993 in Osaka National Hospital were summarized in this paper. A silicone catheter was placed in the hepatic artery through the gastroduodenal artery by operative procedure and connected to a subcutaneously implanted reservoir. 5-FU was administered ambulatorily using Baxter Infusor (multi day type) according to a regimen of 5-day continuous infusion and subsequent 2-day rest. The patients were 4 men and 1 woman, and from 51 to 65 years old (average: 62.4 y.o.). According to criteria for antitumor effectiveness by CT scan, one patient was judged CR, two were PR, and one was PD. One case could not be estimated because of catheter obstruction. The total efficacy rate was 75%. The serum CEA level was reduced in 3 patients. As for complication, obstruction of catheter, damage to reservoir and segmental necrosis of liver were observed in 3 patients. In conclusion, our ambulatory therapy for colorectal cancer patients with liver metastases was considered to have a high potential of not only effectiveness for cancer lesion but also the improvement of patients' quality of life.     

Arterial infusion chemotherapy of 5-FU and leucovorin for patients with liver metastases from colorectal cancer

Fifteen patients with liver metastases from colorectal cancer were treated by arterial infusion of 5-FU and leucovorin. Two regimens were performed. One was weekly bolus infusion of leucovorin following bolus infusion of 5-FU (bolus group), the other was 5 days continuous infusion of 5-FU and leucovorin in 3 weeks (continuous group). One PR was obtained both in the bolus group and in the continuous groups. The objective response rate was 11% in the bolus group and 20% in the continuous group. The one- and 2-year survival rates for these patients were 40% and 0% in the bolus group, and 80% and 60% in the continuous group, respectively. These results suggest that continuous arterial infusion of 5-FU and leucovorin was more effective than individual bolus arterial infusion of leucovorin and 5-FU for patients with liver metastases from colorectal cancer.     

Caring for the caregivers

The relationship between disabled elderly veteran care receivers' functional status and their in-home family caregivers' strain was examined in this study. The convenience sample was composed of 93 dyads. Data were obtained from care receivers' health care records and included the Folstein Mini-Mental State Examination (MMS), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (ADL), and Robinson's Caregiver Strain Index (CSI). Major findings were: 52% of caregivers experienced significant strain; 59% of care receivers were cognitively impaired to some extent and were severely impaired in IADL and ADL; and the relationships between care receivers' functional status (cognitive, ADL and IADL) and caregiver strain were statistically significant.     

Caring for the hypochondriac

The patient's manner and the content of his complaints offer early diagnostic leads. The hypochondriac clings to his symptoms. Rather than relief, his goal is forming a relationship with the doctor that provides care and understanding. The physician's goal must be the provision of this care in such manner as to reassure, treat sparingly and convert this potentially fatal illness to a chronic disorder with which the patient can function to the limits of his capabilities.