Objectives: To describe the clinical, perimetric, and electroretinographic (ERG) results of 4 patients with cone dysfunction following irofulven treatment including the histopathologic and immunocytochemical features ...Objectives: To describe the clinical, perimetric, and electroretinographic (ERG) results of 4 patients with cone dysfunction following irofulven treatment including the histopathologic and immunocytochemical features of one patient’ s retinas. Design: Observational case series. Methods: The patients were examined clinically, including perimetric and ERG evaluations. Eyes from patient 1 and healthy postmortem eyes were processed for histopathologic and immunocytochemistry studies with antibodies specific for cones, rods, and reactiveMü ller cells. Main Outcome Measures: Clinical signs and symptoms, perimetry, ERG, retinal histopathologic and immunocytochemistry study results. Results: All 4 patients had ERG changes consistent with abnormal cone responses and relatively normal rod responses. Compared with control eyes, the retina of patient 1 had approximately half the normal numbers of macular cones and fewer peripheral cones. The number of rods were normal but all rod and cone outer segments were shortened. Conclusion: High-dose irofulven treatment causes cone-specific damage with relative sparing of rods.展开更多
Background. Recurrent ovarian cancer (OVCA) has become the model for ca ncer as a chronic disease, yet little is known about what motivates patients and physic ians in treatment choices. Methods. We investigated the a...Background. Recurrent ovarian cancer (OVCA) has become the model for ca ncer as a chronic disease, yet little is known about what motivates patients and physic ians in treatment choices. Methods. We investigated the attitudes of patients wi th epithelial OVCA and staff towards palliative chemotherapy for recurrent OVCA with a cross-sectional questionnaire study. Results. Instruments were developed and piloted in 15 patients. This exploratory study reflects substantial bias in the sample populations. One hundred twenty-two patients and 37 staff were enro lled in the US and 39 patients and 25 staff were enrolled in the UK. UK patients had a lower educational status (P = 0.001), lower stage disease (P = 0.025), an d less prior lines of chemotherapy (P < 0.001). 61%of patients had recurrent OV CA and 67%of staff were physicians. Seventy-three percent of patients recalled a discussion about prognosis and 74%wanted to know details of the prognosis fo r a typical patient (US = UK). Most patients (48%) thought that their physician was realistic, and 57%of staff felt that they were optimistic. The vastmajorit y of both staff and patients thought that patients positively reinterpreted what they were told. Five percent of staff thought that palliative care was incomp atiblewhen considering chemotherapy as an option for their second recurrence o f OVCA, compared with 36%of US patients, significantly more than the 12%of UK patients (P = 0.007). Patients thought that standard chemotherapy for a second r ecurrence of OVCA produced remission in 50%and cure in 15%of patients. Staff r eported 20%and 0%, respectively. Fifty percent of patients and 57%of staff wo uldwant chemotherapy as an asymptomatic patient with a normal CT and a rising CA -125. Patients generally appear to be very tolerant of grade II chemotherapy-i nduced toxicity with staff being less tolerant than patients of nausea, anorexia , diarrhea, and rash. Staff rated life prolongation by 3 months to 1 year very m uch less acceptable than patients (P < 0.001). Although possibly allowing compre hensive collection of sensitive data, the questionnairewas too distressing for s ome patients and made 11%of patients feel uncomfortably anxious. Conclusions. P atients are optimistic and in the US,may be more reluctant than staff to see the Palliative Care Team. These data challenge the assertion that the use of pallia tive chemotherapy is physician-driven.展开更多
文摘Objectives: To describe the clinical, perimetric, and electroretinographic (ERG) results of 4 patients with cone dysfunction following irofulven treatment including the histopathologic and immunocytochemical features of one patient’ s retinas. Design: Observational case series. Methods: The patients were examined clinically, including perimetric and ERG evaluations. Eyes from patient 1 and healthy postmortem eyes were processed for histopathologic and immunocytochemistry studies with antibodies specific for cones, rods, and reactiveMü ller cells. Main Outcome Measures: Clinical signs and symptoms, perimetry, ERG, retinal histopathologic and immunocytochemistry study results. Results: All 4 patients had ERG changes consistent with abnormal cone responses and relatively normal rod responses. Compared with control eyes, the retina of patient 1 had approximately half the normal numbers of macular cones and fewer peripheral cones. The number of rods were normal but all rod and cone outer segments were shortened. Conclusion: High-dose irofulven treatment causes cone-specific damage with relative sparing of rods.
文摘Background. Recurrent ovarian cancer (OVCA) has become the model for ca ncer as a chronic disease, yet little is known about what motivates patients and physic ians in treatment choices. Methods. We investigated the attitudes of patients wi th epithelial OVCA and staff towards palliative chemotherapy for recurrent OVCA with a cross-sectional questionnaire study. Results. Instruments were developed and piloted in 15 patients. This exploratory study reflects substantial bias in the sample populations. One hundred twenty-two patients and 37 staff were enro lled in the US and 39 patients and 25 staff were enrolled in the UK. UK patients had a lower educational status (P = 0.001), lower stage disease (P = 0.025), an d less prior lines of chemotherapy (P < 0.001). 61%of patients had recurrent OV CA and 67%of staff were physicians. Seventy-three percent of patients recalled a discussion about prognosis and 74%wanted to know details of the prognosis fo r a typical patient (US = UK). Most patients (48%) thought that their physician was realistic, and 57%of staff felt that they were optimistic. The vastmajorit y of both staff and patients thought that patients positively reinterpreted what they were told. Five percent of staff thought that palliative care was incomp atiblewhen considering chemotherapy as an option for their second recurrence o f OVCA, compared with 36%of US patients, significantly more than the 12%of UK patients (P = 0.007). Patients thought that standard chemotherapy for a second r ecurrence of OVCA produced remission in 50%and cure in 15%of patients. Staff r eported 20%and 0%, respectively. Fifty percent of patients and 57%of staff wo uldwant chemotherapy as an asymptomatic patient with a normal CT and a rising CA -125. Patients generally appear to be very tolerant of grade II chemotherapy-i nduced toxicity with staff being less tolerant than patients of nausea, anorexia , diarrhea, and rash. Staff rated life prolongation by 3 months to 1 year very m uch less acceptable than patients (P < 0.001). Although possibly allowing compre hensive collection of sensitive data, the questionnairewas too distressing for s ome patients and made 11%of patients feel uncomfortably anxious. Conclusions. P atients are optimistic and in the US,may be more reluctant than staff to see the Palliative Care Team. These data challenge the assertion that the use of pallia tive chemotherapy is physician-driven.
