Hyperventilation syndrome.
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Alkalosis, Respiratory↗
Biomedical subjects
K Tamminen
Publications and source records attributed to K Tamminen.
Orthostatic increase of respiratory gas exchange in hyperventilation syndrome.
BACKGROUND: Hyperventilation syndrome (HVS) is a common disorder which is difficult to diagnose because of somatic symptoms and its episodic nature. In previous studies respiratory alkalosis in arterial blood was often found during orthostatic tests in patients with HVS. The purpose of this study was to assess these orthostatic changes by non-invasive pulmonary gas exchange measurements and to evaluate whether these responses discriminate patients with HVS from healthy subjects. METHODS: Respiratory gases were collected with a face mask and pulmonary gas exchange was measured after 10 minutes at rest and after eight minutes standing upright in 16 patients with HVS and 13 healthy control subjects. In patients with HVS arterial blood samples were also drawn at rest and in the standing position. RESULTS: At rest the variables of respiratory gas exchange did not differ significantly between the groups. As a response to standing, minute ventilation increased in both study groups but significantly more in the patients with HVS (mean difference 5.4 l/min (95% CI 1.1 to 9.6)). The changes in end tidal CO(2) fraction (FETCO(2)) and in ventilatory equivalents for oxygen (VE/VO(2)) and for CO(2) (VE/VCO(2)) during the orthostatic test were also significantly larger in patients with HVS than in healthy controls. During standing FETCO(2) was significantly lower (mean difference -1.1 kPa; 95% CI -1.5 to -0.6) and VE/VO(2) (mean difference 18.4; 95% CI 7.7 to 29.0) and VE/VCO(2) (mean difference 11.7; 95% CI 4.8 to 18.6) were significantly higher in HVS patients than in healthy controls. By using the cut off level of 4% for FETCO(2) the sensitivity and specificity of the test to discriminate HVS were 87% and 77%, respectively, and by using the cut off level of 37 for VE/VO(2) they were 93% and 100%, respectively. In the HVS patients arterial PCO(2) and FETCO(2) were closely correlated during the orthostatic test (r = 0.93, p<0.0001). CONCLUSIONS: As a response to change in body position from supine to standing, patients with HVS have an accentuated increase in ventilation which distinguishes them from healthy subjects. These findings suggest that non-invasive measurements of pulmonary gas exchange during orthostatic tests are useful in the clinical evaluation of patients with hyperventilation disorders.
Adult↗
Concomitant chemotherapy and IFN-alpha for small cell lung cancer: a randomized multicenter phase III study.
Patients with any stage of small cell lung cancer were given low-dose interferon-alpha (IFN-alpha) from the first day of treatment as long as possible irrespective of changes in treatment dictated by disease progression. All patients received 6 cycles of the chemotherapy (CT): cisplatin 70 mg/m2 i.v. day 1 and etoposide 100 mg/m2 i.v. days 1, 2, 3 every 28 days. Seventy-eight patients were assigned to arm 1: CT alone, 75 patients to arm 2: CT + natural IFN-alpha (3 MU three times a week i.m.), and 66 patients to arm 3: CT + recombinant IFN alpha-2a (3 MU three times a week i.m.). There was no difference in median survival between the arms (10.2 months, 10.0 months, 10.1 months, respectively), p = 0.32. The 2-year survival rates were 15%, 3%, and 11%, respectively. Grade 3 and 4 leukopenia occurred more frequently in the IFN arms than in the CT alone arm and resulted in dose reductions. Antibodies occasionally developed to recombinant IFN. We conclude that IFN-alpha can be administered concomitantly with chemotherapy but is probably better kept for maintenance therapy so that optimal full doses of induction CT can be given.
Adult↗
Phase II study of weekly gemcitabine in advanced non-small cell lung cancer.
New active agents are needed to develop effective systemic therapy against Stage IIIB-IV non-small cell lung cancer (NSCLC). The aim of the present study was to assess the efficacy and toxicity of gemcitabine, a novel nucleoside analogue with significant preclinical activity, as a single-agent therapy. Forty-three patients with previously untreated Stage IIIB-IV NSCLC were included. Gemcitabine was administered intravenously over 30 min on Days 1, 8 and 15 of each 28-day cycle at a dose of 1250 mg m-2. Thirty-seven patients were evaluable for response. There were seven partial responses giving an overall response rate of 19% (95% confidence interval 8-35%). Median duration of response was 6 months. One-year survival and median survival for all patients were 33% and 8 months, respectively. Toxicity of the treatment was mild. World Health Organization (WHO) Grade 3-4 leukopenia was detected in 11% of the patients. Mild (WHO Grade 1-2) nausea was the most frequent subjective side-effect with a rate of 82%. Mild rash and peripheral oedema were typical side-effects of gemcitabine with rates of 19 and 9%, respectively. In conclusion, single-agent gemcitabine is an active and well-tolerated treatment for Stage IIIB-IV NSCLC patients.
Adult↗
Interferon maintenance therapy for small cell lung cancer: improvement in long-term survival.
Two hundred thirty-seven patients with small cell lung cancer (SCLC), who had responded to induction chemotherapy and radiotherapy, were randomly assigned to receive low-dose natural interferon-alpha (nIFN alpha) for 6 months; or 6 cycles of maintenance chemotherapy (CAP); or no maintenance therapy (control group). Although there was no difference in median survival between the groups, there was a significant difference (p = 0.04) in the long-term survival of patients with limited disease, in favour of nIFN alpha maintenance therapy. This finding is now confirmed by a further analysis of the most recent data. Ten percent of patients in the IFN group survived for five years or more, but the 5-year-survival rate in the CAP and control groups was only two percent. All long-term survivors had good performance status. The majority had limited disease and had achieved a complete response to the induction therapy. These results suggest that interferon-alpha improves the long-term survival of SCLC patients for whom other prognostic factors are favorable.
Adult↗
[Fifty years of dental nurse education in Finland].
The first training-course for dental nurses was arranged by the Finnish Dental Association in 1947-1948. Professional help was needed in dental offices in assisting the dentists, taking care of the patients, particularly children, and in cleaning the equipment. As early as 1922 the Scandinavian Dental Association had pointed out that "clinic sisters" would be needed in dental training centers, but the suggestion was not put into effect. The first nine-month curriculum for dental nurses already included all disciplines of dentistry. Lectures in pharmacology, bacteriology and first-aid were also given. Practical training was arranged at the Institute of Dentistry, University of Helsinki. The students further trained for three-week periods both at dental clinics and at privat dental offices. Nine students completed the course and received their diplomas at the end of May, 1948.
Dental Assistants↗
A phase II trial of docetaxel in advanced non-small cell lung cancer.
Twenty-nine patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) were treated with docetaxel. Ten patients had already received chemotherapy, the others had received no chemotherapy. Docetaxel was administrated i.v. over 60 min every 21 days at a dose of 100 mg/m2. Twenty-three patients were evaluable for response. There were no complete responses and eight partial responses. The overall response rate was 35% (28% in the intent to treat analysis). Median duration of response was 43 weeks and median time to progression 12 weeks. Neutropenic infections, neurotoxicity and asthenia were dose-limiting toxicities (6% of 118 cycles). The other main toxicities were asthenia in 48%, skin reactions in 31% and nail changes in 31% of the patients. Single-agent docetaxel appears to be active against both previously treated and untreated advanced NSCLC. Toxicity was acceptable but should be carefully monitored.
Adult↗