Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a Web-based asthma education program.

This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.

Local interferon therapy for melanoma patients.

BACKGROUND: Melanoma, once considered a rare form of cancer, is increasing in incidence throughout the world. The prognosis of malignant melanoma is inversely related to the depth of tumor invasion. METHODS: Twenty-seven patients were treated with r.IFN alpha 2c. Four patients were treated with human natural leukocyte interferon (HNLI). Interferon was applied locally. Historical control groups were used for comparison in the statistical analysis. The data were evaluated taking into account the single risk factor Clark levels III and IV. In the control group there were 10 patients with Clark levels III and IV; in the group of r.IFN apha 2c-treated patients there were 20 patients. The data were analyzed by using the Kaplan-Meier and Cox methods. RESULTS: The percentage of survivals was higher in the interferon-treated groups with Clark levels III and IV, than in the control group, that is 60% compared to 25%, and 40% compared to 33%, respectively. The results of the statistical analysis after 60 months of follow-up are significantly better in the interferon group (P = 0.0175). CONCLUSIONS: The control group was not selected at random. Therefore, on the basis of our results, one can say that the treatment of the melanoma patients, Clark levels III and IV, with the r.IFN alpha 2c is promising and that further investigation is justified.

Mental health needs in Auckland: 1982-6. An analysis using the Jarman index.

Sociodemographic variables obtained from 1986 census data were used to calculate the Jarman index (a measure of underprivilege) for census area units of Auckland. The index was found to correlate with psychiatric admission rates for the years 1982-6 suggesting it might have some utility as an indicator of demand for mental health services. However, the highest admission rates were from particular central city areas reflecting the presence of a deinstitutionalised patient population with chronic mental disorder. This group would appear to require independent assessment of their needs and specific allocation of resources. Factor analysis of the census variable scores comprising the Jarman index revealed principal components equatable with poverty, living without adult company and transient residence.

[Angiosarcoma of the breast--histopathologic and electron microscopy picture]. / Angiosarkom dojke--patohistoloska i elektronskomikroskopska slika.

The authors describe angiosarcoma of the right breast, together with the pathohistologic and electron microscopic analysis and survey of the literature of this rare tumor. The greatest tumor diameter was 4.5 cms. Mastectomy and the axilla's dissection was performed and additionally, radiotherapy was undertaken. In the first biopsy the wrong diagnosis of ductal invasive carcinoma was made. Three years later a metastasis appeared in the left axilla when angiosarcoma was established. The revision of primary tumor of the right breast showed that previously it was angiosarcoma of the right breast, too. In this article the authors direct attention to the possibility of wrong diagnosis of benign or malignant tumor and list the results taken from the world literature. Following those results, the wrong diagnoses were made in 37% of the cases with breast angiosarcoma.

Estrogen and progesterone receptors as prognostic factors in breast cancer.

The relation between estrogen receptors (ER) and/or progesterone receptors (PgR) and some clinical factors such as tumor size, axillary node involvement, histological tumor grade, and disease-free interval (DFI) in 500 patients with operable (TNM stage I-III) breast cancer was studied. ER-positive (ER+) tumors were commoner in older patients, whereas PgR-positive (PgR+) tumors were similarly distributed within the age groups. The concentration of ER+ protein also increased with age in contrast to PgR+ protein concentration. However, receptor status was not associated with menopausal status independently of age. Axillary node involvement influenced neither ER nor PgR status, but there was a statistically significant relation between tumor size and positivity of ER or PgR. There was no association between histologic tumor grade and either steroid receptor phenotype. DFI was longer in patients with ER+ than those with ER- tumors, independently of axillary nodal status. The positivity of PgR in patients with ER+ tumors contributed to an even longer DFI, suggesting that the combination of ER/PgR is a better indicator of DFI than ER or PgR alone.

The significance of cancer cells contaminating postoperative seroma.

Sixth postoperative day seromae of 142 breast cancer patients were searched for the presence of malignant cells. They were found in 32 patients. These patients showed significant propensity of developing distant metastases or having an unfavourable outcome of their disease although the size of their tumours was smaller than in women whose postoperative seromae were malignant-cell free. At the same time TNM tumour staging and axillary lymph node analyses failed to prove any difference between these two groups of breast cancer patients. Finally, the analyses of the state of patients' menstrual cycles showed that cycling women whose postoperative seroma contained malignant cells are at high risk of developing metastases or dying.

Primary adenocarcinoma of the duodenum. Report of two cases.

Between 1969 and 1982, two patients were treated for malignant primary tumors of the duodenum in the Central Institute for Tumors and Allied Diseases in Zagreb. Adenocarcinoma of the posterior wall of the third part of the duodenum was histologically confirmed in the first patient. Today, 11 years after surgery and radiotherapy, there are no signs of the disease. Invasive papillary adenocarcinoma of the third part of the duodenum was histologically confirmed in the second patient. This patient died in cachexia 2 years after the diagnosis. The autopsy confirmed the initial diagnosis, and metastasis in the liver and periduodenal lymph nodes. When establishing the differential diagnosis of undefined pathologic processes in this region, one should consider a primary tumor of the duodenum. Palliative surgery can also be valuable in the overall outcome of treatment.

Histopathologic and histoenzymatic observations in carcinomas treated with human leukocyte interferon.

In this study histologic and histochemical examinations were performed on the bioptic material of 30 cases of head and neck tumors and 34 cases of uterocervical carcinomas after treatment with human leukocyte interferon (HLI). Particular attention was paid to the interaction between stromal and neoplastic cells as a possible host response to the treatment with interferon. In addition to tumor biopsies, regional lymph nodes were also examined microscopically. Stromal cells (macrophages, T and B lymphocytes, and granulocytes) were detected by enzyme-histochemical methods. Histologic and histochemical criteria for classification of tumor biopsies into five groups included the frequency, the cellular composition of peritumoral stroma, the grade of macrophage infiltration into the tumor (expressed quantitatively), and cytologic changes, followed by the regression of tumor. The overall appraisal of patients with cervical carcinoma based on histopathologic and chemical criteria showed the positive effect of HLI therapy in 70% of the cases; observations of head and neck carcinoma treated with HLI showed positive effects in 82% of the cases.

Influence of splenectomy upon immunologic reactivity of patients with Hodgkin's disease.

Since most patients with Hodgkin's disease benefit from splenectomy, a study was designed to explore whether these beneficial effects could be attributed to the recovery of patients' immunologic reactivity. Using a series of ordinary skin test (PPD-tuberculine, Varidase and Candidin) determination of absolute T and B lymphocyte counts in peripheral blood and their mitogenic responsiveness, assessment of immunologic reactivity was performed in 28 Hodgkin's disease patients, prior to and 14 days after splenectomy. The results showed that overall immunologic reactivity of these patients was suppressed as judged by low absolute lymphocyte counts (1747.2 +/- 171.9), lower counts of T (592.0 +/- 92.1) and B cells (295.9 +/- 40.5) and their poor capacity to respond to phytohemagglutinin (PHA) (20342.6 +/- 3662.8 cpm), although the reactivity towards skin test antigens seemed to be well preserved. After splenectomy the reactivity improved, absolute lymphocyte counts raised to 2654.9 +/- 468.8 and were parallelled by an increase in T (936.7 +/- 138.0) and B cell counts (402.2 +/- 81.2). PHA reactivity recovered as well (26965.5 +/- 4035.6 cpm), however, its remained lower than in control cultures. Furthermore, the immunocompetence of patients' spleens was assessed. The possible influence of some suppressive mechanisms such as serum-blocking factor and prostaglandins is discussed.

Application of human leucocyte interferon in patients with urinary bladder papillomatosis, breast cancer, and melanoma.

Eight patients with malignant papillomaosis of the bladder, four with breast cancer, and two with malignant melanoma, all of whom had a poor prognosis, were treated with injection of crude human leucocyte interferon (HLI) into the tumour or the adjacent tissue and in some cases with intramuscular HLI injection also. All tumours showed complete or partial regression after treatment for up to 6 months. One patient with breast cancer died from distant metastases; all other patients in the trial were recurrence-free after 3--30 months of follow-up.

Human leukocyte interferon in therapy of patients with urinary bladder papillomatosis, breast cancer, and melanoma.

The authors report the result of local and parenteral applications of human leukocyte crude interferon in the therapy of eight patients with urinary bladder papillomatosis, four patients with breast cancer, and two patients with melanoma. The doses and effects of treatment are presented in tables. Clinical application of human leukocyte interferon (HLI) to these three types of malignant tumors has yielded encouraging results. The authors believe that investigations on HLI applications to some malignant tumors should continue because the results obtained indicate that interferon possesses not only an antiviral but also an antitumor activity.