Quantification of copper phases, their reducibility and dispersion in doped-CuCl2/Al2O3 catalysts for ethylene oxychlorination.

The comprehensive understanding of the composition, behaviour and reactivity of a catalyst used inside industrial plants is an extremely hard task that is rarely achieved. It requires the use of different spectroscopic techniques, applied under in situ or in operando conditions, and combined with the investigation of the catalyst activity. Often the operating experimental conditions are different from technique to technique and the different results must be compared with care. In the present contribution, we combined in situ XANES/EXAFS, IR spectroscopy of adsorbed CO, CO chemisorption and catalytic tests performed using a pulse reactor in depletive mode. This multitechnical approach resulted in the understanding of the role that dopants (LiCl, KCl, CsCl, MgCl(2) LaCl(3)) have in the nature, relative fraction, reducibility and dispersion of Cu-phases on CuCl(2)/gamma-Al(2)O(3) catalysts for oxychlorination reaction, a key step of the PVC chemistry. In the undoped catalyst two Cu phases coexist: Cu-aluminate and supported CuCl(2), being the latter the only active one [J. Catal., 2000, 189, 91]. EXAFS and XANES highlighted that all dopants contribute more or less efficiently in increasing the fraction of the active copper species, that reaches a value of almost 100% in the case of MgCl(2) or LaCl(3). EXAFS directly, and IR indirectly, proved that the addition of KCl or CsCl (and less efficiently of LiCl) results in the formation of mixed CuK(x)Cl(2+x) or CuCs(x)Cl(2+x) phases, so altering the chemical nature of the active phase. XANES spectroscopy indicates that addition of MgCl(2) or LaCl(3) does not affect the reducibility by ethylene (under static conditions) of the active CuCl(2) phase and that the reducibilility of the new copper-dopant mixed chloride are in the order CuCl(2) > CuLi(x)Cl(2+x) > CuK(x)Cl(2+x) > CuCs(x)Cl(2+x). However, when reduction is done inside a pulse reactor, a more informative picture comes out. The last technique is able to differentiate all samples, and their ability to be reduced by ethylene resulted in the order: La- > Mg- > Li-doped > undoped > K- > Cs-doped catalyst. To understand this apparent discrepancy the dispersion of the active phase, measured by CO chemisorption, was needed: it has been found that addition of LiCl increases enormously the dispersion of the active phase, LaCl(3) significantly and MgCl(2) barely, while addition of both KCl and CsCl results in a decrease of the surface area of the active phase. The mechanism of the enhancing effect of La and Mg on catalytic activity is still not clear, but it could be associated to the modification that they induce to the support surface: the Cu is so highly dispersed that almost all is in direct contact with support surface. It is finally worth noticing that the previous EXAFS and XANES study allowed us to refer the chemisorption data to the active phase only, while the IR study allowed us to fix the Cu(+)/CO surface stoichiometry. Summarizing the use of a multidisciplinary approach has been the conditio sine qua non (mandatory condition) to understand the complex role that the different additives have on the active phase of the CuCl(2)/gamma-Al(2)O(3) catalysts for ethylene oxychlorination.

Factors influencing exercise participation by clients in long-term care.

Lack of participation in regular physical activity by the frail elderly is associated with a decline in physical functioning and an inability to carry out activities of daily living. This in turn, poses greater demands on nursing care that may be required by the client. This study explored factors that influence exercise adherence in frail elderly clients who are living in a long-term care facility. Twelve long-term care clients (5 males and 7 females), aged 74-95 years, participated in the study. Participants were divided into two groups according to their activity patterns (sedentary controls and regular exercisers) and completed a brief questionnaire addressing factors that have been associated with exercise adherence. Data analysis revealed two key factors which determined whether or not clients participated in physical activity programs. The amount of social support provided by significant others and the extent of chronic pain experienced by the client were the best predictors of engagement in regular exercise. Incorporating an understanding of these factors into nursing practice can help the nurse encourage regular physical activity in patients who are living in a long-term care setting. This in turn will help the client maintain his or her ability to carry out activities of daily living.

Evaluation of level I and II axillary nodes included in the standard breast tangential fields and calculation of the administered dose: results of a prospective study.

PURPOSE: To evaluate if Level I and II axillary nodes are included in the standard breast tangential fields, and to calculate the dose administered. METHODS AND MATERIALS: In 35 patients treated with conservative surgery and axillary dissection, three clips were surgically positioned: one at the beginning of Level I, one between Level I and II, and another at the end of Level II. The breast was irradiated with two tangential fields. On simulation films, the volume between the clips was scored as "entirely included" or "not entirely included" in the treatment fields. Computed tomography (CT) scans were performed; CT data were imported into a treatment planning system, and three-dimensional plans were devised. Axillary Levels I and II were delineated on CT slices on the basis of anatomic landmarks. Fields and isodose curves previously obtained were superimposed to calculate the dose administered to the first two axillary node levels and to 90% of both volumes. RESULTS: On X-rays, the volume between clips corresponding to Level I was completely included in the medial field in 66.7% of cases and in the lateral field in 63.7% of cases, whereas the volume of Level II was entirely included in the medial field in 54.5% of cases and in the lateral field in 45.4% of cases. The median dose administered to Level I and II was 38.58 Gy +/- 11.01 (range 3.46-47.14) and 20.65 Gy +/- 14.07 (range 0.95-38.94), respectively. The median dose to 90% of both volumes of Level I and II was 6.75 Gy +/- 14.01 (range 1.9-39) and 1.75 Gy +/- 9.72 (range 0.8-29), respectively. CONCLUSION: The standard tangential fields do not entirely include Levels I and II axillary nodes.

Attribution and serious mental illness: understanding multiple perspectives and ethnocultural factors.

Attributions regarding the nature, cause, and best treatment of mental health problems were examined in a total of 563 adults with serious mental illness from four ethnocultural groups, 185 family members, and 43 mental health practitioners. Attributions agreed in many areas, such as stress as a cause, and medical intervention and counseling as best treatment. Differences were found between the practitioner and other groups in attributions regarding the senses in the nature of mental illness, and in drugs and alcohol as a cause. The role of ethnicity was examined and treatment implications discussed.

Recovery from psychotic illness: a 15- and 25-year international follow-up study.

BACKGROUND: Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS: To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. METHODS: Historic prospective study. Standardised assessments of course and outcome. RESULTS: About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. CONCLUSIONS: A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.

Cirugía selectiva bajo anestesia local para el tratamiento de los adenomas paratiroideos / Selective surgery under local anesthesia for parathyroid adenomas

Introducción. El hiperparatiroidismo primario por adenoma, identificado y localizado por ecografía y gammagrafía, puede ser tratado mediante un acceso limitado, bajo anestesia local y sedación, con la condición de controlar el efecto de la exéresis mediante la dosificación intraoperatoria de la parathormona intacta (PTH-i), y respetar las limitaciones y/o contraindicaciones de esta técnica. Pacientes y método. Se analizan los resultados obtenidos en el tratamiento de 14 pacientes afectados por un hiperparatiroidismo ocasionado por un adenoma de paratiroides (localizado por ecografía y gammagrafía) mediante cirugía selectiva bajo anestesia local y sedación con monitorización intraoperatoria de la PTH-i. Resultados. La anestesia local y la posición operatoria fueron bien toleradas y no hubo complicaciones locales ni re currenciales. La exéresis del adenoma en el orden técnico, no planteó ninguna dificultad. El éxito de la operación se confirmó durante el acto operatorio al comprobar la normalización de los valores de PTH-i a los 30 y 60 minutos tras la exéresis lesional. Conclusiones. La cuestión que subyace es si este método podrá sustituir al acceso quirúrgico tradicional. No obstante, la adenomectomía selectiva paratiroidea, con anestesia local y sedación constituye, en caso de monitorización de la PTH-i, el preludio de una cervicotomía estándar bajo anestesia general (AU)

Weekly schedule of vinorelbine in pretreated breast cancer patients.

PURPOSE: In this phase II study, we explored tolerability and activity of vinorelbine administered according to a dose-dense weekly schedule with hematopoietic growth factor support in pretreated, advanced breast cancer patients. PATIENTS AND METHODS: From January 1994 to March 1996, 40 patients with metastatic breast cancer, pretreated with at least one prior anthracycline-containing regimen, were entered into the study. PATIENT CHARACTERISTICS: median age 53 years (range 32-70); ECOG performance status 0-1: 34 patients, 2: 6 patients; dominant visceral metastatic disease: 15 patients, dominant non-visceral: 25; anthracycline-refractory/resistant: 2 patients, sensitive: 38 patients. Six patients were treated as first-line therapy for metastatic disease and 34 in second- or subsequent lines. All patients received vinorelbine at the dose of 25 mg/m2/week as a short intravenous infusion, together with routine antiemetic medication. Granulocyte-colony stimulating factor (Lenograstim) at the dose of 150 microg/m2 subcutaneously on day 3 was included in the treatment schedule. RESULTS: The median number of treatment weeks was 23 (range: 4-24), with a delivered dose-intensity (DDI) of 23.8 mg/m2/week (range: 18.7-25, 95.2% of projected dose-intensity). Toxicity was mild, with non-complicated neutropenia being the main toxicity observed (grade 3-4 in 25% of the patients but only 2% of treatment weeks). Overall response rate was 52.5%, with complete responses in 12.5% of patients. Median duration of the response and median time to progression were 10 and 9 months, respectively. Median overall survival was 19 months. CONCLUSION: Dose-dense weekly vinorelbine is safe and effective with minimal toxicity in pretreated advanced breast cancer patients.

Regional node failure in patients with four or more positive lymph nodes submitted to conservative surgery followed by radiotherapy to the breast.

A retrospective analysis was conducted to evaluate the incidence of nodal failure in a subgroup of patients who had T1-T2 breast cancer and four or more positive nodes. Sixty-four 5 patients ranging in age from 29 to 73 years (median, 51) received conservative surgery followed by radiotherapy to the breast between November 1980 and May 1995. Adjuvant chemotherapy was administered to 56 patients, 27 of whom were also treated with tamoxifen, which was used alone in 5 patients. Three patients received no adjuvant treatment. Sixty-two patients are evaluable for regional node failure. There were 10 nodal failures, 4 in the axillary and 6 in the supraclavicular regions, in 9 patients, at a median of 56.5 and 27 months, respectively. There was no internal mammary node failure. Median follow-up was 72.6 months. The 10-year probability of developing axillary and supraclavicular failure is 13.9 +/- 7.7% and 10.5 +/- 4.1%, respectively. Prognosis was better for patients with axillary and breast recurrence and worse when relapse was in the supraclavicular region. On the basis of our results and data already published in premenopausal patients, we believe that radiotherapy to the supraclavicular region should be considered in patients with four or more positive axillary nodes, after a complete dissection.

Toxicity and activity of docetaxel in anthracycline-pretreated breast cancer patients: a phase II study.

Docetaxel has proven effective in advanced breast cancer. Myelosuppression and cumulative fluid retention syndrome are troublesome, potentially avoidable toxicities. In this consecutive cohort study, docetaxel (100 mg/m2 by 1 hour i.v. infusion, q3 weeks) activity and toxicity was explored in 56 anthracycline-pretreated patients (eligible: 55: median age: 51 years [range: 28-68 years]; median performance status: 0 [range: 0-3]) with metastatic breast cancer, using two different granulocyte colony-stimulating factor and steroid pre- and postmedication schedules. Twenty-nine patients (group A) received a 5-day oral prednisone premedication, and 26 (group B) received 4-day low-dose i.m. dexamethasone; group B patients also received prophylactic granulocyte colony-stimulating factor. All patients were evaluable for toxicity and 53 for response. Prophylactic granulocyte colony-stimulating factor significantly lowered the incidence of grade III-IV neutropenia and neutropenic fever (p = 0.0001 and 0.01, respectively). The incidence of moderate-severe fluid retention syndrome was lower in patients receiving i.m. dexamethasone (p = 0.08). Overall response rate was 53% (4 complete responses/24 partial responses, 95% confidence interval 39.4-66.2%); 32% have stable disease and 15% progressive disease. In 21 anthracycline-refractory/resistant patients, as well as in 10 paclitaxel-pretreated patients, the overall response rate was 50%. Docetaxel is highly active in anthracycline- and paclitaxel-pretreated metastatic breast cancer, with manageable toxicity. Optimal use of both granulocyte colony-stimulating factor support and steroid premedication deserves further investigation.

Cirugía selectiva bajo anestesia local para el tratamiento de los adenomas paratiroideos / Selective surgery under local anesthesia for the treatment of parathyroids adenomas

El hiperparatiroidismo primario por adenoma, identificado y localizado por ecografía y gammagrafía, puede ser tratado mediante un acceso limitado, bajo anestesia local y sedación, con la condición de controlar el efecto de la exéresis mediante la dosificación intraoperatoria de la parathormona intacta (PTH-i) y respetar las limitaciones y/o contraindicaciones para esta técnica. Se presentan los casos de 14 pacientes operados con éxito de esta manera. La adenomectomía selectiva paratiroidea con anestesia local y sedación constituye, en caso de que la monitorización de la PTH-i no confirme el éxito de la operación, el preludio de una cervicotomía estándar bajo anestesia general. La cuestión que subyace es si este método podrá sustituir al acceso quirúrgico tradicional (AU)

Urbanization, mental health, and social deviancy. A review of issues and research.

This article reviews the international research literature on the relationship of urbanization, mental health, and social deviancy. Attention is called to the multidisciplinary and multisectoral nature of the topic, and to its associated definitional, conceptual, and methodological issues and challenges. Selected research literature on rural-urban differences in mental health and social deviancy is reviewed. There is little consensus on the causal relationship between urbanization, mental health, and social deviancy, although numerous environmental and social pathogenic processes have been posited and investigated. Data indicate rural and urban milieus can have both pernicious and salutary consequences and that more research is needed to specify critical etiological factors and their relationship to subpopulation characteristics. Suggestions for improving future research efforts are offered, including the use of more complex theoretical models, measurement indices, and data analysis procedures.

Allogeneic matched T-cell-depleted bone marrow transplantation for acute leukemia patients.

PURPOSE: We evaluated the efficacy and toxicity of a conditioning regimen designed to overcome the increased risk of rejection and relapse associated with T-cell-depleted bone marrow transplants. PATIENTS AND METHODS: Fifty-four patients with acute leukemia received an allogeneic T-depleted bone marrow transplant from an HLA-matched (n=52) or one locus mismatched (n=2) sibling donor between June 1989 and November 1993. Nineteen acute myeloid leukemia patients and 17 acute lymphoid leukemia patients were in complete remission, and 11 acute myeloid leukemia patients and 7 acute lymphoid leukemia patients were in relapse. Patients were preconditioned with hyperfractionated total body irradiation of 1.2 Gy three times a day on days -9 to -6 (total 14.4 Gy), 10 mg/kg thiotepa on day -5, 4 mg/kg rabbit antithymocyte globulin on days -4 to -1, and 50 mg/kg cyclophosphamide on days -3 and -2. RESULTS: All patients were fully engrafted at a median of 15 days after transplant. No patient rejected the transplant or developed acute or chronic graft-versus-host disease. Of 19 patients with acute myeloid leukemia in complete remission, 14 survive. Four of the 11 patients with acute myeloid leukemia in relapse survive. Twelve acute myeloid leukemia patients died (three of relapse, eight of toxicity, one of other causes). Eleven of 24 patients with acute lymphoid leukemia (one treated in relapse) are alive in complete remission; the other 13 died (nine of relapse, four of toxicity). Interstitial pneumonia, the main cause of toxic death, occurred in 9.26% of total patients. The median follow-up time at this writing is 30 months. CONCLUSIONS: The absence of rejection and graft-versus-host disease and the relatively low relapse and toxicity rates are evidence for the efficacy of our conditioning regimen.

[Percutaneous biliary drainage in obstructions due to malignant pathology]. / Drenaggio biliare percutaneo nelle ostruzioni da patologia maligna.

Experience with percutaneous transhepatic biliary drainage (PBD) in 68 cases of malignant biliary obstructions, is described. 78 procedures (11 external drains, 36 internal-external drains, 17 soft endoprosthesis and 14 self-expandable metallic stents), were performed between December 1989 and December 1991. No significant differences in terms of results were found between internal endoprosthesis and metallic stents. The mortality rate of the procedure was 1.47% (1 case). Complications for the internal prostheses were: obstructions 8 (25.8%), dislodgement 2 (6.5%), cholangitis 1 (3.2%) and metastases along the catheter tract 1 (3.2%). Considering this, the Authors prefer the endoprosthesis instead of external or internal-external drainages.

Counseling and psychotherapy with Japanese Americans: cross-cultural considerations.

The literature of the past two decades on Japanese-American culture, behavior, and mental health services and issues is reviewed. Counseling and psychotherapy with these clients are then discussed, taking into account traditional Japanese cultural values, with particular emphasis on verbal and nonverbal factors affecting therapeutic approaches and communication.

[Preoperative staging and recurrence of rectal tumors. Comparison of transrectal ultrasonography and magnetic resonance]. / Stadiazione preoperatoria e recidive dei tumori del retto. Confronto tra ecotomografia transrettale e Risonanza Magnetica.

The accuracy of transrectal US (TRUS) and of MRI was evaluated in the preoperative staging and in local recurrences of rectal cancers. Fifty-four patients were examined: 45, with known rectal cancer, for preoperative staging, and 9 for the evaluation of local recurrences. Nineteen patients were examined with MRI in basal conditions, 21 after rectal air enema and 5 after paramagnetic contrast enema (Gd-DTPA). The following parameters were evaluated for preoperative staging: wall infiltration, invasion of perirectal fat and adjacent structures, lymph node involvement. Morphologic and signal intensity (on MRI) changes were evaluated for the diagnosis of local recurrences. TRUS provided 2 false positives. In the same patients, basal MRI results were poor, owing to difficult demonstration of the different wall layers, while in the patients studied after air enema, the lesion was hyperintense. In 20 patients with a fat-infiltrating tumor, TRUS provided 3 false negatives and 2 false positives; basal MRI yielded poor results, while air enema and paramagnetic contrast enema clearly demonstrated all fat-infiltrating lesions, with only one false positive.

[Stage I and II cervical carcinoma. Study with magnetic resonance and transrectal echography]. / Il cervicocarcinoma al I e II stadio. Studio con Risonanza Magnetica ed ecografia transrettale.

Twenty-five patients with histologically-proven cervical carcinoma (clinical stages I and II according to FIGO classification system) were studied by means of transrectal US (TRUS) and MR imaging (MRI) at 1.5 T, to evaluate the primary tumor and measure its size. Stage Ib cancers were divided into small 4 (less than 4 cm) and large (greater than 4 cm). The patients with large Ib and those with stage II lesions were administered preoperative radiation therapy. All the patients underwent TRUS, MRI, and clinical examination under sedation; they were subsequently operated. Stage Ia and small Ib patients underwent therapeutic surgery, while large Ib and stage II cases had surgical exploration for pathologic staging. The tumor was correctly identified and measured in 22 patients with MRI, and in 20 cases with TRUS. Tumoral involvement of parametria and uterine ligaments was demonstrated in 75% of cases by MRI and in 62.5% of patients by TRUS. Vaginal involvement was demonstrated by MRI in 77.8% of cases and by TRUS in 66.6% of patients. Tumor size could be evaluated more accurately than with clinical examination under sedation, while the results were poorer in the demonstration of tumor spread into uterus and parametria.

[Transvaginal echography: initial experiences in oncologic gynecology]. / L'ecografia transvaginale: prime esperienze in ginecologia oncologica.

The authors report their initial experience in a selected group of 30 patients with suspected gynecological neoplasms (10 ovarian tumors, 8 recurrences of ovarian tumors, 6 cervical carcinomas, 3 ovarian cysts, 3 fibromyomas) who underwent both transabdominal (US) and transvaginal (TV) sonography. All the scans were retrospectively reviewed. In 18 cases US and TV provided equivalent information as to the organ of origin of the mass, while TV was more useful in 9 cases, and US in 3 cases. The anatomical relationship of the mass to the adjacent organs was better demonstrated by TV in 15 cases, while in 15 cases the information provided by US and TV was equivalent. The two techniques yielded the same results as to the internal architectural details of the mass in 9 cases, while TV was superior in 18 cases and US in 3 cases. TV allowed the early identification of: small amounts of free fluid in the cul-de-sac in 3 cases, compression of the ureter in 1 case, and compression of the uterine vessels in 1 case. These findings had not been demonstrated by US. Our preliminary results indicate that adjuvant TV sonography provides important diagnostic information in gynecological neoplasms in about 39% of patients.