The unmet treatment need for moderate to severe psoriasis: results of a survey and chart review

BACKGROUND: Conventional systemic therapies and phototherapy for psoriasis are limited by safety concerns that may preclude long-term treatment with these agents. OBJECTIVES: To estimate the unmet need for safe and effective treatments for psoriasis. METHODS: A survey was conducted at three psoriasis outpatient clinics in Europe. Male and female patients of any age with psoriasis requiring more than topical treatment were eligible to participate in the survey. Patient data were obtained from patients' answers to a questionnaire as well as by a chart review of each participating patient. The survey questionnaire addressed various aspects of psoriasis, including demographics and disease characteristics, treatment history, pre-existing medical conditions, and patient satisfaction with treatments received. RESULTS: A total of 301 patients participated in the survey, with approximately 100 patients from each centre. Nearly 90% of patients had received at least one systemic therapy or phototherapy for psoriasis, with 39% of patients receiving three or more. Ultraviolet B (UVB), methotrexate, psoralen plus ultraviolet A (PUVA), retinoids and cyclosporin were the most commonly used agents. Inadequate response, reported by patients as no change or worsening of disease with treatment, ranged from 10% to 50%. Contraindications to conventional systemic therapies were reported by 9-22% of patients. A substantial number of patients (42%) were not satisfied with these therapies. CONCLUSIONS: This survey highlights the unmet need for safe and effective therapies for moderate to severe psoriasis.     

High Resolution ECG and Left Ventricular Volume After Acute Myocardial Infarction

The presence of ventricular late potentials (LPs) early after acute myocardial infarction (AMI) was recently reported to correlate with left ventricular dilatation subsequent to AMI. We assessed prospectively the relationship between LP (time domain) in the late phase of AMI and left ventricular end-diastolic volume (EDV) measured by equilibrium radionuclide angiocardiography 4 weeks and 12 months after AMI. In 80 consecutive patients 4 weeks and 12 months after thrombolytic therapy for AMI, LP and EDV were deter mined (EDV1, EDV2). There was no significant correlation between QRS duration (r = 0.18), RMS40 (r = 0.08), or LAS40 (r = 0.1) and EDV1 or EDV2 in patients with or without LP at baseline. In both groups (patients with [n = 15] and without LP [n = 65]), EDVl and EDV2 were comparable (128 ± 32 mL vs 126 ± 35 mL; 114 ± 40 mL vs 117 ± 36 mL; P = NS). In addition, there was no significant difference between EDVl and EDV2 in patients who developed new LP (n = 6) or lost LP (n = 9) 12 months after AMI. In contrast to LP in the very early phase after AMI, there seems to be no significant correlation between the high resolution ECG in the late phase after thrombolytic therapy for AMI and left ventricular EDV.     

PSYCHOSOCIAL ADJUSTMENT AFTER TESTICULAR CANCER TREATMENT

Purpose

The high cure rate in testicular cancer has provoked investigations relating to the quality of life in long-term survivors. We determine the psychosocial consequences of the disease especially in regard to sexual and professional performance.

Materials and Methods

Among the testicular cancer patients treated with various treatment modalities 140 rendered free of disease for at least a year were included in this study. General Health Questionnaire 28 and a general survey were used to determine quality of life issues.

Results

Regarding the sexual life of these patients, problems related to libido, erection and ejaculation increased significantly during treatment and subsequently recovered but did not return to baseline after treatment. During treatment the frequency of sexual intercourse and/or masturbation decreased significantly in all patients. Of the single patients 35% thought that medical history would be a concern for the potential spouse. Regarding professional lives, 22.4% thought that they had better performance after treatment compared to before therapy, whereas only 6.1% reported it to be worse. When professional performance was analyzed according to the treatment modalities those who had received radiotherapy did worse. General Health Questionnaire scores indicated that patients with this disease had a positive view of life compared to that of the normal population.

Conclusions

Although we observed a substantial recovery in sexual life after treatment, it was evident that therapy did have a negative effect on sexual functions. There was no effect on occupational performance and perspective of life, which may be related to the fact of having overcome a life threatening disease.     

Fibroepithelial polyp originating from the glans penis in a child

A fibroepithelial polyp is a benign neoplasm that occurs throughout the urinary tract. In this article, we report a pediatric case of a fibroepithelial polyp originating from the glans penis. To our knowledge, this is a previously unreported lesion arising from the glans penis.     

躁狂抑郁症患者安静状态下的闭眼眼球活动

目的探讨躁狂抑郁症患者闭眼眼球活动（ＣＥＭ）的特征。方法对３１例躁狂抑郁症、３２例精神分裂症患者和２６名正常人进行了研究。每例受检者在安静状态下接受１５分钟闭眼眼电描记，计算最后５分钟内平均每分钟眼电活动的次数。结果躁狂抑郁症患者的ＣＥＭ指标值介于精神分裂症和正常者之间，差异有显著性（Ｐ＜０．０５～Ｐ＜０．０１）；１８例躁狂发作和１３例抑郁发作的患者之间，ＣＥＭ值差异均无显著性；ＢｅｃｈＲａｆａｅｌｓｏｎ躁狂量表或汉米尔顿抑郁量表总分与ＣＥＭ值无显著相关；正在服用精神药物的２３例躁狂抑郁症患者的ＣＥＭ值与未服药的８例患者相比，差异无显著性。结论躁狂抑郁症患者安静状态下的ＣＥＭ具有其本身的特征，此特征有可能作为与精神分裂症患者和正常对照者的区别点     

Multi-institutional analysis of cervical esophageal carcinoma patients treated with definitive chemoradiotherapy: TROD 01-005 study

The aim of this study was to examine the prognostic factors and treatment outcomes of cervical esophageal carcinoma (CEC) patients who underwent definitive chemoradiotherapy (CRT). The clinical data of 175 biopsy-confirmed CEC patients treated with definitive CRT between April 2005 and September 2021 were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were assessed in uni- and multivariable analyses. The median age of the entire cohort was 56 years (range: 26–87 years). All patients received definitive radiotherapy with a median total dose of 60 Gy, and 52% of the patients received cisplatin-based concurrent chemotherapy. The 2-year OS, PFS, and LRFS rates were 58.8%, 46.9%, and 52.4%, respectively, with a median follow-up duration of 41.6 months. Patients’ performance status, clinical nodal stage, tumor size, and treatment response were significant prognostic factors for OS, PFS, and LRFS in univariate analysis. Non-complete treatment response was an independent predictor for poor OS (HR = 4.41, 95% CI, 2.78–7.00, p < 0.001) and PFS (HR = 4.28, 95% CI, 2.79–6.58, p < 0.001), whereas poor performance score was a predictor for worse LRFS (HR = 1.83, 95% CI, 1.12–2.98, p = 0.02) in multivariable analysis. Fifty-two patients (29.7%) experienced grade II or higher toxicity. In this multicenter study, we demonstrated that definitive CRT is a safe and effective treatment for patients with CEC. Higher radiation doses were found to have no effect on treatment outcomes, but a better response to treatment and a better patient performance status did.     

Determinants of the Natural Course of Ventricular Late Potentials After Thrombolytic Therapy for Acute Myocardial Infarction

The intraindividual changes of ventricular late potentials and their possible determinants were examined prospectively in 88 consecutive patients (male: 75; mean age: 58 ± 9 years) after thrombolytic therapy for acute myocardial infarction. Late potential analysis was performed 4 weeks and 12 months after acute myocardial infarction. At the same time, a left heart catheterization was performed to assess the extent of coronary heart disease and left ventricular ejection fraction. The incidence of late potential 4 weeks after acute myocardial infarction was 15% (13/88 patients). Eighteen percent (16/88) of the patients revealed changing results of late potential analysis: 9 patients lost late potential (late potential pos./neg.) 1 year after acute myocardial infarction and 7 patients presented new formation of late potential (late potential neg./pos.). Preserved late potentials were found in four patients (late potential pos./pos.). Late potential analysis remained negative in 68 patients (late potential neg./neg.). There was no influence of age, gender, site of infarction, clinical course, and medical treatment on the natural course of late potential. Changing results of late potential analysis seemed to be correlated with the evolution of left ventricular ejection fraction and the dynamics of coronary heart disease. In the group late potential pos./pos., comparable values for left ventricular ejection fraction were measured at both examinations, whereas late potential neg./neg. had a significant increase in ejection fraction. In the group late potential pos./neg., a significant improvement in left ventricular function was also measured. In contrast, the late potential neg./pos. group tended to have lower left ventricular ejection fractions 1 year after infarction. In the late potential neg./pos. and late potential pos./pos. groups, the extent of coronary artery disease returned to conditions comparable to baseline despite an initial reduction after coronary revascularization performed 4 weeks after infarction. Late potential neg./neg. and late potential pos./neg. revealed a stable benefit gained from coronary revascularization with a persistent reduction in the number of diseased vessels. Dynamic changes in the results of the signal-averaged ECG 1 year after thrombolytic therapy for acute myocardial infarction were observed in 18% of the patients. These changes seem to be correlated with the evolution of left ventricular function and the dynamics of coronary artery disease.     

烧伤后深静脉血栓预防实用指南

深静脉血栓及其引起的肺栓塞是我国烧伤专科医护人员相对忽视的一种严重并发症，因其“极少发生”而疏于防范，在烧伤临床工作中，我们常常认为某些患者的猝死是由于“严重吸入性损伤”气道突然堵塞（尤其是使用翻身床翻身的患者）、脂肪乳输注不当、对重症烧伤患者护理不到位等引起，事实上，在这些猝死的患者中可能有一定比例的患者是由于致命性的肺血栓栓塞引起的，有些患者的深静脉血栓（DVT）由于同时合并下肢烧伤而“认为肢体肿胀系创面引起”，从而遗漏了DVT的早期诊断、早期治疗，因此，可以认为目前我国烧伤临床所诊断的DVT／PTE可能只是冰山一角。事实上，近年来现代临床医学发现，DVT的发生率远较既往的“认为”要大，因此越来越重视DVT的预防和治疗，尤其是外科患者，在循证医学的基础上制定了外科患者DVT防治指南，烧伤专业虽系外科学的一个分支，但有其特殊性，目前国内外还没有一致的烧伤后DVT防治指南。我国烧伤专科医生对烧伤患者尤其是下肢烧伤、大面积烧伤患者普遍没有采取DVT／PTE的预防，但在美国，2005年有71个烧伤中心参与的一项调查发现，有75％的烧伤中心常规对烧伤患者进行DVT预防，预防措施包括持续使用压迫器（装置）、皮下注射肝素和低分子肝素、静滴肝素，因此通过此文，希望能够提醒广大烧伤专科医护人员，要重视DVT／PTE的防治，同时也呼吁大家能够开展烧伤后DVT／PTE的流行病学调查和防治研究，因为到目前为止尚无有关DVT的循证医学的Ⅰ类证据指导临床。