Ethics and total parenteral nutrition: issues for intravenous nurse professionals.

Healthcare ethics is a hot topic these days. Decisions to withhold or withdraw various forms of medical therapy are daily events in most hospitals and long-term care facilities. Intravenous nurse professionals do not need to be bioethicists; however, they do need to be able to identify problems quickly and know how to address them. Some of the ethical issues that could be encountered by i.v. nurse professionals involved in the provision of total parenteral nutritional support in various clinical settings are examined and explored.

Phase II of doxorubicin/taxol in metastatic breast cancer. Argentine Multicenter Taxol Group.

PURPOSE: To assess the response rate, survival, and toxicity of Taxol (paclitaxel) as 1-h infusion plus doxorubicin as first-line treatment for patients with metastatic breast cancer (MBC). PATIENTS AND METHODS: Seventy-six patients with untreated MBC were recruited. All of them had measurable disease and were evaluable for toxicity. Fifty-five percent of the patients had visceral involvement. The dose of doxorubicin was fixed at 50 mg/m2 as a short intravenous infusion, followed by 200 mg/m2 of Taxol as a 1-h intravenous infusion. Doxorubicin was administered during the first seven cycles, continuing with Taxol only up to a maximum of ten cycles. RESULTS: Neutropenia was the most important toxicity: 30% grade 3 and 18% grade 4. Only 2 patients showed a decrease in the left ventricular ejection fraction (LVEF) which caused discontinuing the treatment. No clinical congestive heart failure (CHF) was observed. Seventy-four patients were eligible for response evaluation: 10 (14%) achieved complete response (CR) and 46 (62%) achieved partial response (PR). The mean duration of response was 13.47+/-1.35 months (95% confidence interval (CI): 10.82; 16.12) and the mean survival was 21.50+/-1.42 months (95% CI: 18.72; 24.29). CONCLUSION: The overall response (OR) rate was 76%. No CHF was assessed and 2 patients stopped treatment due to LVEF decrease. Although doxorubicin 50 mg/m2 followed by Taxol 200 mg/m2 in 1-h intravenous infusion presents a toxicity profile which demands a close follow-up, it represents a convenient outpatient schedule with similar activity rate compared to longer Taxol infusions.

Home intravenous therapy down under.

Health service research traditionally has relied on quantitative methodologies that view the question from the researcher's perspective. Exploring the question of what it is like to receive intravenous therapy at home has required investigation into what is known about home i.v. therapy and the impact on the patient in particular. The purpose of this study was to describe and understand the recipient's lived experience of home i.v. therapy using a research approach that preserves the uniqueness of the experience from the recipient's perspective. The method involved conducting in-depth interviews with a sample of 26 recipients of home i.v. therapy throughout Tasmania, Australia. Interviews were analyzed using an interpretative process, with the participants describing a process that included the main themes of "having a life" and "the hazards of hospitalization." The main goals of the work are to heighten nurses' and other healthcare professionals' understanding and awareness of home i.v. therapy from the consumer perspective and to address the lack of patient/consumer advocacy and exploration within the evaluative literature available on this subject.

Paclitaxel in platinum-resistant ovarian cancer patients. Argentine Multicenter Taxol Group.

Paclitaxel (Taxol; Bristol-Myers Squibb Company; Princeton, NJ) is an antineoplastic agent that inhibits microtubular function and has shown efficacy in several solid tumors, mainly ovarian tumors, in which 20% to 40% response rates in previously treated patients were observed. We conducted a study to assess survival, response rate, and toxicity associated with paclitaxel treatment in patients with advanced ovarian cancer resistant to platinum therapy. Between September 1994 and November 1996, 38 patients were admitted for study and 37 were evaluable. All had disease progression or relapse within 1 year of receiving platinum-containing first-line chemotherapy. Mean age was 59 years (range, 30 to 75 years), all had bulky disease, and 18 showed increased carbohydrate antigen-125 at admission. They were treated every 3 weeks with paclitaxel 175 mg/m2 as a 3-hour infusion, preceded by standard premedication. Response rate was 51.3%, with a median response duration of 10.0 months and a median survival rate of 16.8 months. Mild to moderate hematologic toxicity was observed with only one episode of grade 4 neutropenia, without fever. Gastrointestinal toxicity was moderate and peripheral neuropathy was mild, except for two patients who had concomitant pathologies or previous treatment, which might have caused some neuropathy. We concluded that paclitaxel given as a 3-hour infusion was easily administered for ambulatory treatment, with mild to moderate toxicity and promising results based on rate and duration of response as well as survival.

p53 protein expression in human breast carcinoma: lack of prognostic potential for recurrence of the disease.

Mutations of the p53 gene are now known to be one of the most commonly detected genetic defects among human cancers. Because of its stability, the mutant p53 protein can be detected by immunohistochemical methods. Overexpression of the mutant p53 protein has been suggested as a prognostic indicator for the recurrence of breast cancer. Using a monoclonal antibody to p53, formalin-fixed, paraffin embedded breast cancer tissues retrieved from up to 10 years storage in the archival files were processed for staining. A total of 125 cases was examined p53 overexpression was identified by brown nuclear staining. Clinical parameters studied included estrogen and progesterone receptors, tumor size, nodal status, obesity, stage, and histopathological grade. The only significant association seen for p53 overexpression was with negative estrogen and progesterone receptors. All other clinical parameters studied were independent of p53 overexpression. Thus, p53 overexpression does not appear to be a useful prognostic indicator for recurrence and survival in human breast cancer.

Early and delayed skin reactivity to solubilized antigens of herpesvirus hominis 1 in psychiatric patients and guinea pigs.

Intradermal tests with a mixture of Herpesvirus hominis 1 (HVH 1) antigens containing quantitated neutralization antigen were done in 39 schizophrenics (SCH), 42 senile demented (DS) persons, 28 alcoholics, neurotics and psychopaths (ANP) and 33 control persons. Local induration, erythema and fading was evaluated according to diameter and intensity after 15 to 30 min for anaphylactic type I reaction, after 5 hr for Arthus type III reaction and after 24 and 48 hr for delayed hypersensitivity (type IV). The diagnosed clinical forms influenced the incidence of positive reactions I, III or IV at the level alpha = 0.01. The incidence of positivity in all reactions (I, III plus IV) was significantly higher in the patients than in the control group. Type I and III reactions were most intensive in ANP and SCH, respectively. Type IV reaction was most pronounced in SCH, including the highest incidence of purple lesions, eventually with a lightly cyanotic target. In the DS group, type IV reaction surpassed the control the least of all patients' groups. Unfavourable side effects of the skin tests were not observed. The importance of repeated contact with HVH 1 for a marked type IV reaction ws confirmed in experimentally infected guinea pigs, which also served for safety tests and selection of antigen preparations.

Assay of interferon and viral antibodies in the cerebrospinal fluid in clinical neurology and psychiatry.

Cerebrospinal fluids (CSF) of 245 neurological and 194 psychiatric patients were tested for viral antibodies and interferon. Complement dependent neutralizing antibodies to Herpesvirus hominis 1 were found in the CSF of patients with encephalitis (50.6%), meningitis (35.4%), lesions of peripheral nerves (36.9%), sclerosis multiplex (41.2%), schizophrenia (31.9%), senile dementia (51.4%), mental retardation (11.1%), ethylism (43.5%). Neutralizing antibodies to tick-borne encephalitis virus were found in the CSF of 38% patients with encephalitis, in 14% meningitis, 11% lesions of peripheral nerves and also in 5.6--11.8% of psychiatric patients. In encephalitis, meningitis and in lesions of peripheral nerves were found in the CSF frequently plaque neutralizing antobidies to the tick-borne orbivirus Lipovník, complement-fixing antibodies to lymphocytic choriomeningitis virus and hemagglutination inhibiting antibodies to measles virus. In multiple sclerosis were detected CSF antibodies to measles virus (44%), Herpesvirus hominis 1 (41.2%) and Lipovník virus (52.6%). In neurological patients were observed CSF antibodies simultaneously to two or three viruses in 16.7 to 40.6%, while in psychiatric patients in zero to 4.6%. CSF interferon was found in psychiatric patients with an equal or even higher incidence (33.7 to 57.1%) than in the neurological patients (29.6--38.6%, in multiple sclerosis only 16.7%). Non-interferon virus inhibitors were excluded. The evaluation of the ratio of serum and CSF titers of viral antibodies and of interferon indicated local synthesis of both in the central nervous system -- with the exception of antibodies to Herpesvirus hominis 1 in CSF of some patients with very high titres in serum and probable lesions of the blood brain barrier.

Psychopharmaca and electroconvulsive therapy in relation to viral antibodies and interferon. Experimental and clinical study.

Chlorpromazine (CHP) in a concentration of 8.3 microgram per ml medium inhibited attachment and multiplication of CEC and of various cell lines. The same CHP concentration applied to grown CEC monolayers inhibited the growth of TBEV but not the growth of HHV 1, while interferon was slightly stimulated. The clinical course of fatal subcutaneous TBEV infection in mice was not affected by daily CHP treatment while brain and serum interferon were stimulated. Antibody formation in TBEV infected or HHV 1 immunized mice was not affected significantly by CHP application. The following data were obtained in a longitudinal study on 28 hospitalized schizophrenic patients: 89 percent of them revealed at least some serological findings which indicate an actual HHV 1 infectious process-elevated NAB titers, high ratio between complement requiring and complement not requiring NAB titers. A low interferon activity was observed in serum and cerebrospinal fluid of 93 percent and 14 percent patients, respectively. No regular correlation between HHV 1-NAB-both complement requiring and complement not requiring-and of interferon on one side and between hospitalization. CHP treatment and electroconvulsive therapy on the other side has been observed.

Search for herpetic antibodies in the cerebrospinal fluid in senile dementia and mental retardation.

Complement-requiring neutralizing antibodies to herpes simplex type 1 virus (HSV 1) in titres from 2 to greater than 16 were detected in the cerebrospinal fluid (CSF) of 47% senile patients with various forms of dementia, but in none of mentally retarded adolescents and adults suffering from various neurologidal diseases. Also the incidence of HSV 1 serum antibodies in elevated titres (larger than or equal to 512) was increased in senile demented patients (61%) as compared with persons in normal senium (31%), normal adults (15%), mentally retarded adolescents (17%) and prisoned felons with low IQ (45-47%).