Management of Constipation in Patients with Cancer

In patients with cancer, constipation is a common complication. However, unlike in the general population, the impact of the symptoms of constipation on the quality of life in cancer patients is often greater. More importantly, in patients who are in the more advanced stages of the disease, constipation may also be suggestive of disease progression. Constipation as a symptom in this population is of significant importance as it may lead to life-threatening complications, i.e. bowel perforation due to fecal impaction. Therefore, in this regard, this problem deserves particular attention, as early recognition and management of complications may prevent further physical deterioration. This review aims to provide an overview of the management of constipation in patients with cancer. A symptom-based criteria definition for chronic constipation and prevalence of the problem in cancer patients provides a brief introduction. For the initial assessment and evaluation of constipation in cancer patients, an algorithm is described. The different possible etiologies of constipation in cancer patients are also discussed. Regarding therapeutic management, guidelines and recommendations for the use of different types of laxatives, stool softeners, suppositories and rectal enemas, prokinetic agents, antidepressant medications, and miscellaneous agents are succinctly discussed. Management of fecal impaction and opioid-induced bowel dysfunction are also described. Lastly, a brief overview of the management of acute colonic pseudo-obstruction and surgical or endoscopic options for large bowel obstruction are described.     

1987 survey of military optometrists: activities, roles and attitudes

A worldwide survey of active duty military optometrists (Air Force, Army and Navy) was conducted in the spring of 1987. The survey response rate was 79%. Statistically significant differences (alpha = 0.01) in their roles, activities and attitudes are presented and discussed. Significant interservice differences were found in: types of duties, profession/status of immediate supervisors, work assignments, frequency and types of patient encounters, awareness of therapeutic drug policies, access to specific clinical instruments, and frequency of routine clinical tests. Attitude and opinion tabulations suggest an overall satisfaction with professional experiences and interprofessional working relationships. However, there was a common perception that optometrists did not receive appropriate promotional consideration or career opportunities within this multidisciplinary setting. Implications of survey results for non-military multidisciplinary health care institutions are also discussed.     

Scabies associated with radiation therapy for cutaneous T-cell lymphoma

Scabies, infection with Sarcoptes scabiei, is known to be predisposed to by poor body hygiene, environmental exposure, and systemic immunodeficiency. We report the case of an 83-year-old man with Sezary's syndrome who developed scabies limited to the skin of the upper chest, the same location where he had previously received electron beam radiation treatments for cutaneous T-cell lymphoma. Histologic and immunohistochemical studies demonstrated that sections of the previously irradiated right and left chest skin, compared to non-irradiated chest, abdominal, and leg skin, had infestation by scabies, diminished involvement by T-cell lymphoma, and notably reduced numbers of Langerhans cells. These findings suggest that the development of scabies may be predisposed to by local cutaneous radiation therapy, and that it may be mediated by local cutaneous immunodeficiency secondary to reduced numbers of Langerhans cells.     

Multilamelled structures from the lungs of patients with pulmonary alveolar proteinosis

Multilamellated structures (MS), which accumulate in the lungs of patients with pulmonary alveolar proteinosis, were examined under the electron microscope. MS, in general, consisted of alternating light and dark lamellae arranged concentrically about membranous vesicles or electron-dense bodies. The darker osmiophilic lamellae consisted of trilaminar membranes 80 to 100 A thick, and the lighter lamellae, which varied from 150 to 300 A in width, appeared amorphous. MS made up 42.6 +/- 12.4% (n = 4) of the total particulate volume present in the pulmonary lavage effluents. MS resembled tubular myelin structures from the lungs of patients, although these latter structures accounted for only 1.6 +/- 2.3% (n = 4) of the total particulate volume. Abnormalities, such as polygonal tubules, irregular tubule dimensions, and large size potential, indicated that tubular myelin structures in the lungs of patients were variable in structure. MS appear to be a form of tubular myelin structure. MS were treated with a variety of disruptive agents and then examined under the electron microscope. Information was obtained about the composition of the MS and the intermolecular forces involved in their three-dimensional organization. Extraction of the MS with acetone or treatment of the structures with phospholipase c resulted in loss of membranes from the structures without a concomitant loss of the intermembranous amorphous material, indicating that phospholipids were a major membrane component. Analysis of phospholipids in the acetone extracts of the MS revealed that the membranes consisted of 45% phosphatidylcholine and that the major fatty acid of the phosphatidylcholine was palmitate (76%). The amorphous material of the intermembranous spaces consisted primarily of protein, since it was destroyed by the proteases trypsin and pronase without loss of the membranes. Reducing agents such as mercaptoethanol and dithiothreitol were disruptive, indicating the importance of disulfide bridges between the protein constituents in maintaining the integrity of the MS. The significance of hydrophobic interactions between the protein constituents was demonstrated by the disruptive action of chaotropic agents according to the sequence KSCN greater than KI greater than KCl. These data indicate that MS consist of phospholipid membranes organized in a protein matrix maintained by intermolecular disulfide bridges and hydrophobic interactions.