Information Needs of Cancer Patients and Perception of Impact of the Disease, of Self-Efficacy, and Locus of Control.

The aim of our study was to investigate the relationship between information needs and cancer patients' perceptions of the impact of the disease, self-efficacy, and locus of control. Using a standardized questionnaire, we obtained data from patients who attended a series of lectures. The questionnaire included questions on their information needs, sources of information, satisfaction with information, and short questionnaires on self-efficacy, perception of the disease, and locus of control of reinforcement. Data was obtained from 185 patients. Our results showed that the sources of information that were most often used were physicians (84 %), print media (68 %), and the Internet (59 %); online fora (7.5 %), non-medical practitioners (9.7 %), and telephone-based counseling (8.6 %) were only used by a minority. Patients with a high perception of their own control over the disease more often used any source of information available to them and were more often interested in acquiring additional information. Higher self-efficacy was significantly associated with the need for information on all topics. Patients with a higher external locus of control significantly more often used sources of information and had significantly more need for additional information. By contrast, there were no associations with an internal locus of control. Neither external nor internal locus of control showed any associations with satisfaction with information. Information needs seem to be higher in patients with a high external locus of control and low self-efficacy. Physicians, other professionals, and institutions that provide information may take these relationships into consideration for tailoring their services to patients.

Carotid artery stenting in patients with symptomatic carotid stenosis: a single-center series.

OBJECTIVES: Carotid angioplasty with stenting (CAS) in patients with carotid stenosis (CS) has become more restricted in France especially since the disclosure of such studies as EVA-3S and Stent-supported percutaneous angioplasty of the carotid artery versus endarterectomy (SPACE). This report is of a series of CS cases contraindicated for endarterectomy that underwent CAS at a French center of interventional neuroradiology. PATIENTS AND METHODS: Fifty-five patients with symptomatic CS more than 60% consecutively submitted to CAS between September 2008 and February 2011. The primary endpoint was either death or stroke within 30 days of the procedure; a secondary goal was to identify any possible factors that might have influenced the success and outcome of the intervention. RESULTS: The overall periprocedural stroke/death rate at 30 days was 5.4% (three out of 55 patients), with three non-disabling strokes and no deaths. Twenty-seven patients (49.1%) were treated with a cerebral protection device (CPD). Stent placement was achieved in all cases. Open- and closed-cell stents were implanted in 40 (72.7%) and 15 procedures (27.3%), respectively. Neither the use of a CPD, the carotid stent cell design nor any anatomical or technical factors were associated with a lower risk of stroke or death within 30 days of CAS. CONCLUSION: CAS in symptomatic patients with CS contraindicated for endarterectomy in this selected French series proved feasible and safe, with acceptable levels of morbidity. Use of a CPD, type of stent (open- or closed-cell), and anatomical and technical factors had no influence on the success of the procedure or the outcome within 30 days of the operation.

Fully automated preoperative segmentation of temporal bone structures from clinical CT scans.

Middle- and inner-ear surgery is a vital treatment option in hearing loss, infections, and tumors of the lateral skull base. Segmentation of otologic structures from computed tomography (CT) has many potential applications for improving surgical planning but can be an arduous and time-consuming task. We propose an end-to-end solution for the automated segmentation of temporal bone CT using convolutional neural networks (CNN). Using 150 manually segmented CT scans, a comparison of 3 CNN models (AH-Net, U-Net, ResNet) was conducted to compare Dice coefficient, Hausdorff distance, and speed of segmentation of the inner ear, ossicles, facial nerve and sigmoid sinus. Using AH-Net, the Dice coefficient was 0.91 for the inner ear; 0.85 for the ossicles; 0.75 for the facial nerve; and 0.86 for the sigmoid sinus. The average Hausdorff distance was 0.25, 0.21, 0.24 and 0.45 mm, respectively. Blinded experts assessed the accuracy of both techniques, and there was no statistical difference between the ratings for the two methods (p = 0.93). Objective and subjective assessment confirm good correlation between automated segmentation of otologic structures and manual segmentation performed by a specialist. This end-to-end automated segmentation pipeline can help to advance the systematic application of augmented reality, simulation, and automation in otologic procedures.

Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients.

BACKGROUND AND PURPOSE: To report our experience in the treatment of brain arteriovenous malformations (BAVMs) using Onyx (ev3, Irvine, Calif). PATIENTS AND METHODS: From January 1999 to October 2004, 94 patients with BAVMs were treated endovascularly in our department. They were 51 (54%) men and 43 (46%) women with a mean age of 32 years. A total of 210 endovascular procedures were performed with Onyx as the sole embolic agent in 88 procedures; Onyx and n-butyl cyanoacrylate (n-BCA) were used in combination in 50 procedures, and n-BCA alone was used in 72 procedures. RESULTS: The course of endovascular treatment was completed in 53 patients. In 26 patients (49%, 26/53) an angiographic cure was achieved using embolization as the sole therapeutic technique. Seven (13%, 7/53) patients underwent a surgical resection of the residual BAVM nidus, 20 (38%, 20/53) patients underwent radiosurgical treatment after nidal size reduction <2 cm was accomplished by endovascular treatment. Further endovascular treatment was planned in 33 patients, whereas in 5 patients, the continuation of embolization was aborted due to difficult nidus catheterization. Procedure-related permanent neurologic deficits were observed in 8 (8.5%, 8/94) patients. There were 3 procedure-related deaths. CONCLUSION: Onyx is suitable for brain BAVM embolizations and allows obtaining higher rates of anatomic cures compared with those obtained previously with other embolic agents.

Influence of Carotid Siphon Anatomy on Brain Aneurysm Presentation.

BACKGROUND AND PURPOSE: Intracranial aneurysm is a devastating disease of complex etiology that is not fully understood. The purpose of this study was to assess the implications of carotid siphon anatomy for the formation and development of intracranial aneurysms. MATERIALS AND METHODS: Between January 2007 and May 2015, lateral view digital subtraction angiographic images of 692 consecutive patients with intracranial aneurysms treated in our department of interventional neuroradiology were reviewed and had their angles measured. Data on the location, presentation, and size of the lesions were collected and evaluated by multivariate analysis in relation to the measured angles. RESULTS: Of 692 aneurysms, 225 (32.51%) ruptured and 467 (67.49%) unruptured, 218 (31.50%) were in the carotid siphon and 474 (68.50%) were distal to the siphon, and the mean aneurysm size was 7.99 ± 6.95 mm. Multivariate analysis showed an association between angles of >15.40° and rupture (P = .005), postsiphon location (P = .034), and aneurysm size of >1.001 mm (P = .015). Multivariate analysis also showed that every 1-year increase in patient age produced an increase of 1.002 mm in aneurysm size (P = .015). CONCLUSIONS: There was a significant independent direct relation of greater anterior knee angle with intracranial aneurysms located distal to the carotid siphon, larger aneurysms, and greater risk of rupture. These findings may be associated with the hemodynamic interactions of blood flow and the curvature of the carotid siphon.

Risk factors for male breast cancer.

To investigate risk factors in male breast cancer, a case-control study of 52 histologically diagnosed cases and 52 controls--matched for age, race, marital status, and hospital--was conducted in 5 U.S. metropolitan areas. Cases were significantly more likely to be Jewish than were the controls, supporting earlier suggestions of an increased risk in Jewish males. A significant association of male breast cancer with mumps infections at age 20 years or older, along with the possible association with antecedent testicular injury and the excess frequency of mumps orchitis among cases, suggests that testicular factors may be important in the development of breast cancer among males. An increased frequency of breast cancer among persons who have worked in blast furnaces, steel works, and rolling mills is of interest because of the possible testicular effect of high environmental temperatures. The observed association between breast cancer and a prior history of swollen breast is difficult to interpret because of potential recall bias, and a possible relationship with military service needs further confirmation.

Perspectives on the epidemiology of cervical cancer with special reference to the herpesvirus hypothesis.

PIP: Epidemiological considerations with regard to mortality statistics and incidence rates for cervical cancer are discussed and recent data are summarized. The unresolved problem of the nature of the relationship between cervical dysplasia and carcinoma in situ with invasive cervical cancer is considered. A summary is made of data on time trends in the incidence of cervical cancer and of the details of studies on the biological behavior of cervical carcinoma in situ. Coital/marital and penile factors in the etiology of cervical cancer are reviewed, and the herpesvirus hypothesis is evaluated in light of methodological considerations. Finally, a major new collaborative prospective test of the herpesvirus hypothesis is proposed.^ieng

Human cervical cancer as a venereal disease.

The operation of venereal factors in human cervical cancer is suggested by demographic and epidemiological data. Recent evidence supporting the genital herpesvirus hypothesis is consistent with this notion. A controlled epidemiological investigation has been undertaken on the role of the male coital partner in cervical carcinogenesis. An answer is sought to the question, "Is the risk of developing cervical cancer increased among the wives of men who at some other time were married to other women who developed cervical cancer?" With one-quarter of the study completed, a total of 14 marital clusters have been identified in which 2 or more wives of the same men developed cervical carcinoma. The expected number of such clusters is estimated to be 4.

Treatment of severe chronic venous insufficiency with ultrasound-guided foam sclerotherapy: a two-year series in a single center in Brazil.

OBJECTIVES: To portray the initial experience at a public health center of the Federal District of Brazil in the treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy in patients in advanced stages of the disease. METHOD: Eighty-seven reports of patients in C5 and C6 stages, according to CEAP classification, were evaluated for clinical improvements, ulcer-healing rates, and complications of ultrasound-guided foam sclerotherapy. McNemar test was used for statistical analysis with the level of significance set at 5% (P-value, 0.05). RESULTS: The results showed high rates of ulcer healing (85%) and significant improvement of symptoms after treatment, such as pain, heaviness, fatigue, burning, paresthesia, and itching (P < 0.0001). CONCLUSIONS: An outpatient, low-cost and high-resolution technique, without the need for hospitalization and use of the operating room showed to be a safe and effective alternative for the treatment of varicose disease associated with severe chronic venous insufficiency.

A community laboratory for studies on low-risk cancer agents.

This paper presents the concepts underlying the establishment of a community epidemiological laboratory that could serve the diverse needs of investigators worldwide who are involved in a variety of studies on low-risk lung cancer agents. The desiderata for selecting a specific geographically defined community are suggested together with a discussion of practical applications.

The problem of the older primipara.

The obstetric data relating to 98 older primiparas (OP) (0.21% of all deliveries) are compared with 100 randomly chosen older multiparas (OM) and 100 young primiparas (YP). Notable differences observed were a higher incidence of toxemia and a greater incidence of uterine myomata in the OP group. No difference was seen in the incidences of diabetes, cardiac disease, and essential hypertension. There was a greater number of preterm deliveries. The frequencies of induction of labor, vacuum extraction, and cesarean section were much greater in the OP group. No difference in postnatal course was detected among the 3 groups. No significant increase in perinatal morbidity was observed, but the incidences of prematurity and perinatal mortality were higher. It seems that the attending obstetrician is much quicker to decide to terminate pregnancy or labor ithe OP group. Except for the need for special attention to prematurity and perinatal mortality, the OP group is not at high risk.

Teledermatology and in-person examinations: a comparison of patient and physician perceptions and diagnostic agreement.

OBJECTIVE: To compare physician and patient impressions and interphysician diagnostic agreement between live teledermatology and in-person examinations. DESIGN: Paired video and in-person examinations with different dermatologists. SETTING: An urban Veterans Affairs dermatology clinic. PATIENTS: One hundred thirty-nine patients. MAIN OUTCOME MEASURES: Satisfaction questionnaires and interphysician diagnostic agreement. RESULTS: Patient and physician satisfaction was high. Agreement between video and in-person diagnoses was 80%. CONCLUSIONS: Physicians and patients were satisfied with teledermatology examinations. Diagnostic agreement between in-person and video dermatologists was high.

A muscarinic receptor different from the M1, M2, M3 and M4 subtypes mediates the contraction of the rabbit iris sphincter.

In order to analyse the subtype of muscarinic receptors involved in the methacholine-induced contraction of the rabbit iris sphincter we have determined equilibrium dissociation constants (KB) of various antagonists in the sphincter muscle. The values were compared with those observed at M1 (rabbit vas deferens), M2 (heteroreceptors in rat iris) and M3 receptors (guinea-pig ileum), or at the muscarinic receptors in the guinea-pig uterus. The methacholine-induced contraction of the uterus from immature guinea-pigs was competitively antagonized by pirenzepine (6.64, -log KB), 4-DAMP (8.39), hexahydrodifenidol (HHD; 7.00 for the (R)- and 5.40 for the (S)-enantiomer), p-fluoro-hexahydrosiladifenidol (p-F-HHSiD; 6.25) and valethamate bromide (8.04). The affinity of the antagonists is consistent with the presence of an M2 receptor. The -log KB values of the antagonists in the rabbit iris sphincter (6.43, p-F-HHSiD; 6.22, AQ-RA 741; 7.23 and 5.34, (R)- and (S)-trihexyphenidyl) were lower than, or within the lowest range of, estimates in the other experimental models, irrespective of the subtype selectivity of the antagonist. This excludes the presence of an M1, M2, M3 or M4 receptor in this smooth muscle. The affinity of UH-AH 37 in the iris was intermediate between that for M1 or M3, and M2 receptors. The low affinity of AQ-RA 741 and the low enantiomeric ratio of trihexyphenidyl (THP) in the iris (77.6) would be compatible with a presumed M5 receptor.(ABSTRACT TRUNCATED AT 250 WORDS)

A simplified technique to correct hyperextension deformity of the metacarpophalangeal joint of the thumb.

A flexible hyperextension deformity of the metacarpophalangeal joint of the thumb in eleven patients was repaired by tendon reinforcement of the volar capsule of the joint using the tendon of the extensor pollicis brevis. This tendon, which was regarded as a deforming factor, was left attached at its insertion on the proximal phalanx and was divided at the musculotendinous junction proximally. The mobilized tendon was pulled out distally and then passed proximally and volarly, first superficial to the sheath of the long flexor tendon and then back through a hole in the neck of the metacarpal, and finally in a distal direction to form a criss-cross pattern and be sutured to the tendon of the adductor pollicis. The procedure gave reliable results after an average follow-up of 6.5 years in these eleven patients who had rheumatoid, paralytic, and traumatic lesions.

Distraction-lengthening of digital rays in the management of the injured hand.

The distraction-lengthening principle and apparatus, formerly used in the hand for reconstruction in congenital anomalies and traumatic amputations, is described for reconstruction of metacarpals and phalanges shortened by injuries, especially gunshot wound, where those bones have lost significant length. Hands in which single metacarpals have been shortened or in which multiple digits are involved may benefit from the technique.

Synovectomy of the elbow in rheumatoid arthritis.

Twenty-five synovectomies of the elbow were performed in twenty-one patients with rheumatoid arthritis, and the patients were followed for two to eleven years. All patients had an advanced stage of the disease, with disintegration of cartilage and severe erosions of bone. The operations were performed by the same surgeon using the same technique. Follow-up studies revealed various degrees of improvement in all patients. The improvement in motion was most evident in rotation of the forearm. Pain was diminished in all but three patients. In five elbows a few degrees of flexion and extension was lost. The favorable response to synovectomy was retained throughout the follow-up period in twenty-four elbows. In only one elbow was there recurrence of the synovial swelling, about eight years after the operation.

Snapping elbow due to dislocation of the medial head of the triceps. A report of two cases.

Two cases of unusual snapping at the elbow are described. In both, the medial head of the triceps was found to be separated from the main muscle belly. During flexion of the elbow, the medial head dislocated over the medial epicondyle, producing a characteristic snapping phenomenon. Both cases were of long standing and had been asymptomatic for years. The first clinical symptoms were those of an ulnar neuropathy. In order to restore the normal position of the medial head of the triceps, its tendon was detached from the olecranon, passed under the central tendon and interlaced to it. The ulnar nerve was left in the epicondylar groove in one case and transposed anteriorly in the other. At the end of the procedure flexion of the elbow was unobstructed and the snapping phenomenon had disappeared.

Epidemiological considerations in the role of dendritic/Langerhans cells in human cancer.

The roles of dendritic or Langerhans cells in human neoplasia have been studied in animal models and human subjects for some years. Much has already been learned concerning the operative immunological processes, relationships with other components of the reticuloendothelial system, and correlations with genetics and the aging process. Unfortunately, the present requirement for microscopic examination of human tissues to assay these cells greatly limits the types of study which can be under-taken and their scope. Investigations must presently be limited to human cancers occurring in readily accessible sites such as the uterine cervix, urinary bladder and skin. In the future, it is anticipated that new experimental approaches can be developed which permit the measurement of DC/LC activity levels without the need for biopsy specimens, thus greatly enhancing research possibilities in the important arena of biomedical investigation.

Maternal mortality in an Israeli hospital: a review of 23 years.

In spite of great strides in obstetrics, maternal mortality has been completely eliminated. Possible changes in the causes of mortality are examined for three periods of time (1954-1961, 1962-1971 and 1972-1976). The overall incidence was 3.6/10 000, changing through the three periods from 4.9 to 4.3 and finally to 3.0/10 000. Vascular accidents were the cause of death in almost one third of the cases, emerging as the most important etiologic factor. Older age and higher parity did not seem to influence the incidence of obstetric deaths. Cesarean section was involved in ten of 23 cases in which the death was directly related to the pregnancy and delivery. In six patients there was a rupture of the uterus. The number of preventable deaths has decreased steady, but research into the problem of vascular accidents and dampening of the enthusiasm for cesarean sections may further improve the situation.

PIP: Despite scientific advances in obstetrics, maternal mortality is still a serious problem in many countries. This paper analyzes the causes of maternal mortality in Kaplan Hospital since its opening in 1954 up to 1976. 27 women died during this period; total number of deliveries was 63,997. The period was divided into 3: 1954-61, with a mean number of deliveries of 2386 per year; 1962-71, with a mean number of deliveries of 2308 per year; and 1972-76, with a mean number of deliveries of 4244/year. Maternal mortality for the 1st period was 4.9/10,000; in the 2nd, 4.3/10,000 and in the last, 3.0/10,000. Confidence limits based on the Poisson distribution method was used to test for statistical significance. Causes of direct maternal death included: 1) vascular accidents (amniotic fluid embolism and disseminated intravascular clotting) which accounted for almost 1/3 of all cases; 2) infection; 3) EPH gestosis or toxemia of pregnancy; 4) hemorrhage; and 5) anesthesia. Indirect causes of death included cardiac cases, followed by pulmonary embolism, cerebrovascular andirenal diseases, in decreasing order of importance. Older age and parity did not affect incidence of obstetric deaths. This report indicates a definite decline in maternal mortality for the 3 periods. The decline was attributed to liberal use of better antibiotics, emphasis on aseptic techniques, better antenatal care and well-equipped operating theaters. Nevertheless, vascular accidents remain the major direct cause of maternal deaths. Further research should be done on vascular accidents and its prevention; a healthy respect for the use of ceasarian sections may also be helpful in reducing further maternal deaths.

Re-evaluation of the obstetrical risk for the older primipara.

The obstetric data relating to 92 older primiparas (OP) treated as regular obstetric patients and data relating to 92 older multiparas (OM) are compared to a previous study of 98 OP, which led to the conclusion that OP should not be managed as high-risk patients during gestation. No difference was found between the two periods regarding complications of pregnancy, gestational age and birth weight, onset of labor, perinatal morbidity and mortality. Nevertheless, cesarean deliveries were significantly higher in the study group. It seems that the conservative attitude towards OP during pregnancy is justified, but at labor, more rigid indications for cesarean section should be applied to establish objective patient care.

PIP: 1st delivery at an older age is still considered to be a special event, and the older or elderly primipara (OP) still attracts attention now and then in the obstetric literature. The incidence of OP in the population did not change with time. Late marriage ranks 1st as a cause for old primipariy. The obstetric data relating to 92 older primiparas treated as regular obstetric patients and data relating to 92 older multiparas are compared to a previous study of 98 OP, which led to the conclusion that OP should not be managed as high-risk patients during gestation. No difference was found between the 2 periods regarding complications of pregnancy, gestational age and birth weight, onset of labor, perinatal morbidity and mortality. Nevertheless, cesarean deliveries were significantly higher in the study group. It seems that the conservative attitude towards OP during pregnancy is justified, but at labor, more rigid indications for cesarean section should be applied to establish objective patient care.