Do concordances of social support and relationship quality predict psychological distress and well-being of cancer patients and caregivers?

This study examined concordances of cancer patients' received and caregivers' provided support and dyadic relationship quality, and their predictive utility in prospective psychological distress and well-being. A total of 83 Chinese cancer patient-caregiver dyads were recruited in two government-funded hospitals in Hong Kong. Participants reported received (patient)/provided (caregiver) emotional and instrumental support and dyadic relationship quality within 6 months after diagnosis (T1), and anxiety and depressive symptoms, positive affect and life satisfaction at both T1 and 6-month follow-up (T2). We hypothesised that concordances at T1 would predict lower psychological distress and higher psychological well-being among both patients and caregivers at T2. Concordances were indicated by Gwet's AC2 scores (possible range = -1.00 to 1.00) and as follows: emotional support: M = 0.92, SD = 0.12, range = 0.25-1.00; instrumental support: M = 0.92, SD = 0.16, range = 0.08-1.00; and relationship quality: M = 0.63, SD = 0.27, range = -0.31 to 1.00. Hierarchical multiple regressions revealed that T1 concordances of perceived emotional and instrumental support and dyadic relationship quality positively predicted T2 anxiety symptoms [F(9, 74) = 6.725, ∆R2  = .031, p < .001)] and state positive affect [F(9, 74) = 3.436, ∆R2  = .042, p = .001)], whereas inversely predicted T2 depressive symptoms [F(9, 74) = 4.189, ∆R2  = .042, p < .01)]. Significant associations were found only among caregivers, but not patients.

A phase II study of pemetrexed combined with cisplatin in patients with recurrent or metastatic nanopharyngeal carcinoma.

Pemetrexed is a novel chemotherapy agent with good efficacy and toxicity profiles. This phase II study aimed at evaluating its use in combination with cisplatin for recurrent or metastatic nasopharyngeal carcinoma (NPC). All participating patients had metastatic or recurrent NPC with prior treatment by platinum-based chemotherapy. The study regimen comprised of pemetrexed 500 mg/m(2) and cisplatin 75 mg/m(2), repeated 3-weekly for 4 cycles. Efficacy evaluation was based on both radiological and biochemical responses. Patients with no progressive disease and good tolerance were given another 2-4 cycles. Fifteen patients were treated for a total of 4-8 cycles (median, 6 cycles); 9 had distant metastases and 6 had loco-regional recurrences only. Reduction of DNA copies of EB virus by ≥50% was observed in 93% accessible patients, with 21% of them being biochemical complete response (CR). Radiologically, 1 (7%) patient achieved CR, 2 (13%) achieved partial response and 8 (53%) had stable diseases. The median time to progression was 30 weeks. Treatment was well tolerated with only 1 (7%) patient developing grade 4 toxicity (of anemia). The most common grade 3 toxicities were neutropenia (27%) and anemia (20%). The baseline mean total QOL scores (as measured with FACT-H&N version 4) was 100.4 and showed no significant change after the fourth cycle (95.6, p=0.20) and sixth cycle (91.9, p=0.15). Pemetrexed in combination with cisplatin is a well tolerated regimen with encouraging efficacy for metastatic and recurrent NPC. Further evaluation of its role in the management of NPC is warranted.

A case of Langerhans' cell histiocytosis of the lung presenting with haemoptysis.

Langerhans' cell histiocytosis of the lung can be part of a multisystem disorder or an isolated disorder. Ninety percent of adult patients with Langerhans' cell histiocytosis of the lung are smokers. This article reports a case of Langerhans' cell histiocytosis presenting with haemoptysis. The diagnostic signs on chest X-ray, high-resolution computed tomography, and histology are highlighted, followed by a short review of the literature.

All that wheezes is not asthma.

Asthma is a common disease. Wheezing is not pathognomonic of asthma, however. One must be alert when appropriate asthmatic treatment does not provide adequate control. Other causes of airway obstruction must be considered, especially when stridor is heard. This report describes an elderly patient who had been managed as having asthma but had an endotracheal tumour.

Cost-effectiveness of CT thorax and bronchoscopy in haemoptysis with normal CXR for exclusion of lung cancer.

As fibre-optic bronchoscopy and CT thorax become more widely used, patients with haemoptysis who had normal CXR and sputum results are more commonly offered both CT and bronchoscopy to exclude lung cancer. Doctors who are under possible litigation pressure arising from missed diagnoses of lung cancer are often exhaustive in their investigations, even when the haemoptysis has been transient. The present study aims to investigate the number of cancer patients who can be detected with the two investigations, and compare recent similar study results with archive results. We found that despite the use of more efficient investigation tools, the yield is paradoxically much lower and, hence, less cost-effective than that of previous studies. The likely reason is that doctors tend to over-investigate, even for short-term, minimal blood-streaked sputum, which is common among simple bronchitis. In order to be more cost-effective, these investigations should be used more selectively and for high risk patients such as those with prolonged haemoptysis and those who are heavy smokers.

Pulmonary haemorrhage in a patient with Kikuchi disease.

Kikuchi disease is an immunologic disease and most commonly presents with cervical lymphadenopathy. It is usually self-limiting [1]. It is sometimes associated with systemic lupus erythematosus (SLE) [2], and can be associated with many complications including aseptic meningitis, neuropathy, brachial neuritis. It can also be associated with lymphoma, and may sometimes be misdiagnosed as such [3]. The following is the first reported case of Kikuchi disease associated with pulmonary haemorrhage. The patient died and no other cause of the pulmonary haemorrhage could be identified at post mortem.

An unusual case of laryngeal scleroma.

An unusual case of nasal and laryngeal scleroma is presented. Laryngeal scleroma should be included in the differential diagnosis of obstructing lesions of the supraglottic airway. The immunoperoxidase staining method is useful in establishing the diagnosis in cases of equivocal culture and histopathologic appearance. It can further be used as an objective test to determine the effectiveness and duration of antibiotic therapy.

Corticosteroids in airway management.

Adrenal corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling. The corticosteroid effect is nonspecific. In upper airway obstruction caused by edema from infection, allergy, or trauma, corticosteroids will exert some degree of suppressive effect. The steroid effect is local and directly proportional to the concentration of steroids in the inflamed tissue. In upper airway obstruction steroids should be delivered to the inflamed tissue in high concentration with the least delay. Dexamethasone and methylprednisolone produce high blood levels within 15 to 30 minutes of intramuscular injection. Recommended initial doses for acute airway obstruction are dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg. The risk of harm from steroid therapy of 24 hours or less is negligible.

Scleroma (Rhinoscleroma). A histologic immunohistochemical study with bacteriologic correlates.

Scleroma was diagnosed in nine of 30 Spanish-surnamed patients who had inflammatory lesions of the nose, pharynx, and larynx during the two-year period from Jan 1, 1978, through Dec 31, 1979. A total of 19 biopsy specimens were taken from these nine patients. In six of the 19 specimens, a histologic diagnosis of scleroma was not possible. Seventeen of the specimens with characteristic histologic findings stained with the peroxidase-antiperoxidase method for detection of Klebsiella capsular antigen III, although in 11 of these specimens, simultaneous cultures failed to reveal the characteristic Klebsiella rhinoscleromatis. These specimens showed the features of one of the three histopathologic forms of scleroma: ozena, granuloma, or scleroma. A range of tissue reactions was identified: histiocyte and plasma cell nodules, vasculitis, acute inflammation, pseudoepitheliomatous hyperplasia, ulceration, and submucosal keratin cyst. Comparison with histochemical bacterial stains revealed that the PAS and Hotchkiss-McManus stains gave unequivocal positive results less frequently than the immunoperoxidase method, and were less specific. Methenamine silver, Giemsa, Deiterle, Brown and Brenn, and Brown and Hopps were unreliable for the detection of the organism. The immunoperoxidase method can be appropriately used when the spectrum of histopathologic findings suggests a differential diagnosis of scleroma.

Clinical update on rhinoscleroma.

Rhinoscleroma is recognized more frequently now because of the recent influx of immigrants from endemic Central America. This chronic infectious disease presents with three overlapping clinical stages and can involve any part of the respiratory tract. A review of the clinical presentation leads to a patient evaluation plan consisting of physical examination and radiographic studies. A highly sensitive and specific method is introduced for identification of Klebsiella rhinoscleromatis in the biopsy specimen using the immunoperoxidase technique. A study of the immune status of the patient revealed general immunological competence except in effective phagocytosis of the organism by the Mikulicz cells. The choice of chronic antibiotic therapy should be guided by individual patient consideration with respect to age and sex. Repeat biopsies help determine the duration of antibiotic therapy. Relapses do occur and close observation is the key to long-term follow-up of the patient.