Changes in marital and sexual functioning in long-term survivors and their spouses: Testicular cancer versus hodgkin's disease

This study compares the effects of the cancer experience on various aspects of marital and sexual functioning (e.g., communication, emotional support, body image, sexual satisfaction and frequency) for two groups of long-term cancer survivors (testicular cancer and Hodgkin's disease) and their spouses. Comparisons between the two patient groups showed significantly more survivors of Hodgkin's disease than testicular cancer reporting the emergence of special issues and changes in the marital relationship. No differences emerged between the spouse groups on sexual functioning variables; however, spouses of survivors of Hodgkin's disease were more likely than spouses of survivors of testicular cancer to report the development of special issues and communication difficulties. A substantial proportion of both survivor groups disclosed negative changes in body image and sexual frequency. Majorities of both survivors and spouses acknowledged that the illness had drawn them closer together. When representative marital/sexual functioning variables were used to predict Family Environment Scale (FES) scores for survivors and for spouses, changes in the spouse's importance, influence of the illness on the relationship, and changes in sexual frequency emerged as significant predictors. The clinical significance of long-term changes in marital and sexual functioning for the couple and the need for therapeutic interventions are discussed.     

Acute mastoiditis — Relevant once again

Summary During recent years, a significantly increased incidence of acute mastoiditis was observed at the University Children's Hospital, Tübingen, Germany (1975–1979: 1.4 patients/year; 1987–1992: 4.2 patients/year; p<0.05). We therefore reviewed the records of all patients with acute mastoiditis (n=58) that had been treated at the Children's Hospital between 1975 and 1992 and at the Clinic of Otorhinolaryngology between 1978 and 1992. The male to female ratio was 1.8:1 and 60.4% of the patients were younger than 24 months. Retroauricular swelling was more often observed (n=49) than protrusion of the pinna (n=45) and retroauricular redness (n=38).Streptococcus pneumoniae was the most frequently isolated pathogen. Several factors predisposing for the development of acute mastoiditis were identified. These included withholding antimicrobials for treatment of the preceding episode of otitis media; use of suboptimal agents for therapy of otitis media (penicillin and, possibly, erythromycin ethylsuccinate); and insufficient duration of treatment.

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Akute Mastoiditis — wieder ein aktuelles Problem

Zusammenfassung In den letzten Jahren wurde an der Univ.-Kinderklinik Tübingen eine signifikante Zunahme der Inzidenz der akuten Mastoiditis beobachtet (1975–1979: 1,4 Patienten/Jahr; 1987–1992: 4,2 Patienten/Jahr; p<0,05). Wir analysierten daher die Krankengeschichten aller Patienten mit akuter Mastoiditis (n=58), die zwischen 1975 und 1992 an der Universitäts-Kinderklinik und zwischen 1978 und 1992 an der Universitäts-Hals-Nasen-Ohrenklinik behandelt worden waren. Das Verhältnis von Jungen zu Mädchen betrug 1,8:1, und 60,4% der Patienten waren jünger als 24 Monate. Eine retroaurikuläre Schwellung wurde häufiger beobachtet (n=48) als ein abstehendes Ohr (n=45) und eine retroaurikuläre Rötung (n=38).Streptococcus pneumoniae war der häufigste Erreger. Mehrere für das Auftreten einer akuten Mastoiditis prädisponierende Faktoren wurden gefunden: die Nichtbehandlung der vorausgegangenen Otitis media mit Antibiotika, der Einsatz suboptimaler Antibiotika (Penicillin und möglicherweise Erythromycin-Ethylsuccinat) für die Otitis-Behandlung und eine ungenügende Therapiedauer.

     

Identification of a 28 kDa lychee allergen as a triose-phosphate isomerase

The aim of this study was to investigate the allergenic potency of the exotic fruit lychee (Litchi chinensis SONN.). For this purpose the lychee protein extract was separated by ion exchange chromatography and a purified allergen with a molecular weight of 28 kDa was identified by N-terminal sequencing and peptide mass fingerprinting. Both methods determined the lychee allergen as a triose-phosphate isomerase. To this protein 67% of patients showed allergic reactions respectively IgE binding of their sera. Similar enzymes from other plants were also recognized as allergens.     

Hodgkin disease: contributions of chest CT in the initial staging evaluation

Chest radiographs and chest computed tomography (CT) scans were compared in 203 patients with newly diagnosed Hodgkin disease. The incidence of positive findings was tabulated from six intrathoracic lymph node groups, lung parenchyma, pericardium, pleura, and chest wall. The discordant cases were assessed to determine impact on clinical management. The CT scans provided additional evidence of disease involvement, ranging from 0% to 15% at each of the designated anatomic sites. Treatment was altered in 9.4% of all patients (19 of 203), including 13.8% (nine of 65) of those undergoing radiation therapy alone and 8.2% (ten of 122) of those undergoing combined-modality treatment. We conclude that routine chest CT examinations are valuable in the clinical management of those patients for whom radiation therapy is planned.     

The Stanford experience with combined procarbazine, Alkeran and vinblastine (PAVe) and radiotherapy for locally extensive and advanced stage Hodgkin's disease.

This report describes the efficacy and toxicity of PAVe (procarbazine, Alkeran, vinblastine) and irradiation (RT) in the management of 159 patients with locally extensive or advanced stage Hodgkin's disease (HD) at Stanford University. Patients received six courses of chemotherapy alternating with RT. The extent of RT and the schedule of treatment varied according to the stage of disease. About 2/3 of patients received PAVe/RT in the setting of prospective, randomized clinical trials. The rate of complete response was 93%. With a median follow-up of seven years (range 2-17), the 15 year actuarial freedom from progression (FFP) is 78% and overall survival is 75%. Ten-year FFP by stage is: 80% for locally extensive stage II, 90% for stage IIIA and 70% for stage IIIB. Excellent and equal results were attained with PAVe/RT vs. MOP(P) (mustard, Oncovin, procarbazine with or without prednisone)/RT in the randomized combined modality studies. Progression or recurrence was documented in 30 patients and was more common in irradiated sites. PAVe was well tolerated acutely. There were no treatment related fatalities. Twenty-three (14%) patients were admitted to the hospital for neutropenic fever. Five second malignancies have occurred after PAVe/RT only: one myelodysplastic syndrome, one acute myelogenous leukemia, one non-Hodgkin's lymphoma and two solid tumors including a case of non-small cell lung cancer and an in situ carcinoma of the cervix. Three patients died from myocardial infarction several years after the completion of treatment. These mature data show that PAVe/RT is effective and well-tolerated therapy for locally extensive stage II and IIIA/B HD.(ABSTRACT TRUNCATED AT 250 WORDS)