Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey.

OBJECTIVE: The objective of this study was to assess the prevalence and associated factors of sexual activity, sexual problems or sexual satisfaction in French early-stage breast cancer survivors (BCS). METHODS: Eight hundred and fifty eligible, post-treatment (6 months-5 years) female patients, aged 18-70 years, randomly selected from a consultation list, were invited to fill in questionnaires exploring quality of life (EORTC QLQ-C30 and QLQ-BR23), body image scale, and sexuality (Sexual Activity Questionnaire-SAQ; Relationship and Sexuality Scale; French Sexual Behaviour Survey-CSF). RESULTS: Fifty-three percent of BCS agreed to participate. Participating women (n=378) were younger, more often premenopausal at diagnosis and with a more recent diagnosis than non-respondents. The prevalence of sexual problems was significantly higher in BCS compared with adjusted data from a French female representative sample (p<0.0001). In logistic regression, no sexual activity (R(2) =0.37) or sexual dissatisfaction (R(2) =0.28) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, poorer body image, or co-morbidities. In sexually active women (71% of respondents), lower frequency of sexual activity (R(2) =0.26), lower sexual pleasure (R(2) =0.22), or higher sexual discomfort (R(2) =0.22) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, age (>50 years), nausea, or insomnia (all Hosmer-Lemeshow tests: p=NS). CONCLUSIONS: Psychological factors including the perception of the couple relationship appeared prominent in BCS women's experience of sexual problems.

Mifepristone (RU486), a pure antiprogesterone drug, in combination with vinblastine for the treatment of progesterone receptor-positive desmoid tumor.

We report the case of a patient who developed a desmoid tumor following total proctocolectomy and J-pouch reconstruction that was unresponsive to any medical treatment. Based on estrogen receptor alpha (ERalpha) and progesterone receptor (PR) evaluation (ERalpha-negative, but PR-positive), treatment with mifepristone, a pure antiprogesterone drug, was initiated, and partial tumor regression was achieved.

Role of physical activity and sport in oncology: scientific commission of the National Federation Sport and Cancer CAMI.

This overview reports published data about the interaction between physical activity and sport during and after cancer on one hand and improvement in psychological parameters, survival and biological mechanisms underlying this effect on the other hand. Practising physical activity and sport during cancer modifies parameters assessing fatigue and quality of life and reduces symptoms of depression. An association also exists between the practise of physical activity and sport and overall and cancer-specific survivals, especially after breast cancer, colon cancer and prostate cancer. These benefits seem to be mediated by a modification of circulating levels of estrogens, insulin, IGF-1 and by a decrease in insulin-resistance, by alterations in the secretion of adipokines, and by a reduction in chronic inflammation through decreased levels of cytokines. There exist some obstacles to the practise of physical activity. These obstacles are mainly related to a fear of pain induced by physical activity and to overweight. These programmes of physical activity and sport cannot be offered to all patients since there are several contra-indications, with some being present since the initial visit and others appearing during cancer management either due to disease progression or related to iatrogenic effects. Whereas benefits from physical activity and sport among cancer patients seem obvious, there are still several pending clinical and biological issues.

Decreased whole blood 5-hydroxytryptamine (serotonin) in AIDS patients.

Significantly (p less than 0.001) decreased whole blood unconjugated serotonin levels were detected in AIDS patients as compared to patients with advanced cancers and to healthy individuals.

Do oncologists have an increasing interest in the quality of life of their patients? A literature review of the last 15 years.

The aim of this review is to evaluate the extent to which Quality of Life (QoL) assessment has been incorporated into clinical oncological trials in the last 15 years. All phase II and III trials published in the Journal of Clinical Oncology, Cancer, The British Journal of Cancer and the European Journal of Cancer during the years 1980, 1985, 1990 and 1995 were reviewed (n = 827). During this period, while the number of studies assessing performance status (PS) increased from 15% in 1980 to 56% in 1995, the number of trials noting a QoL assessment increased only slightly, from 0% in 1980 to 3% in 1995. Moreover, only four of the 13 studies with a QoL evaluation met our criteria for adequate QoL assessment. Thus, despite an increasing interest in QoL, it is still rarely included as an objective in clinical trials, or adequately assessed.

Preoperative radiation therapy and surgery in the treatment of "bulky" squamous cell carcinoma of the uterine cervix (stage Ib, IIa, and IIb operable tumors).

Forty-two women with "bulky" squamous cell carcinoma of the uterine cervix, larger than 5 cm, were treated between 1982 and 1988. The median follow-up was 5 years (from 37 to 106 months). The age range was from 25 to 77 years (mean: 49). There were 14 stage Ib, 5 stage IIa, and 23 stage IIb operable patients. Forty grays were delivered at mid-plane of the pelvis (23 fractions in 31 days) using the four-field technique (6-18 MV). External beam radiation therapy was followed by 20 Gy of intracavitary radiation therapy. Forty-eight days later total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and bilateral pelvic lymphadenectomy were performed. The 3- and 5-year disease-free survival was 83 and 81%, respectively. The 5-year locoregional control rate was 83%. Thirteen patients suffered from mild to severe complications (31%) but there were only two long-term (5%) complications.

Mediastinal infusion of epirubicin and 5-fluorouracil. A complication of totally implantable central venous systems. Report of a case.

Perforation of the wall of the superior vena cava by a central venous catheter is reported. The resultant inadvertent infusion of 5-fluorouracil and epirubicin caused a severe acute inflammatory reaction in the right-lobe bronchus, mediastinal infiltration and pleural and pericardial effusions. The patient recovered but has residual mild oesophageal dysfunction.

Improved survival of hospitalized patients with acute myocardial infarction from 1981-1983 to 1992 in Israel. The SPRINT Study Group and The Israeli Thrombolytic Survey Group. Secondary Prevention Israeli Nifedipine Trial.

BACKGROUND: This study compares in-hospital and 1-year mortality rates in two large cohorts of patients with acute myocardial infarction (AMI) who were admitted to coronary care units in Israel in 1981-1983 and in 1992. Since the late 1960s and early 1970s there has been a remarkable decline in mortality from cardiovascular causes in most Western countries; the reason for this decline is not completely understood. Although several studies have shown a significant decrease in in-hospital mortality from AMI between the 1960s and the 1980s, studies comparing survival after AMI between the 1980s and 1990s are relatively scarce. Over the past decade important medical treatments and procedures for the management of AMI were introduced. METHODS: Between August 1981 and July 1983, 5839 consecutive patients were admitted to 13 coronary care units in Israel with a confirmed diagnosis of AMI. Demographic and medical data from hospital charts were recorded. Mortality follow-up was complete for 99% of hospital survivors for a mean period of 10 years. A second cohort of 623 consecutive patients with AMI hospitalized during January and February of 1992 in the same 13 coronary care units were followed up for 1 year after discharge. RESULTS: Sex distribution and mean age were very similar in the two cohorts. Unadjusted in-hospital mortality was 18% in 1981-1983 versus 11% in 1992 (P < 0.001). After multiple regression analysis, the in-hospital mortality odds (adjusted for age, sex and history of previous infarction) declined from 1981-1983 to 1992 by 22-67%. The reduction in in-hospital mortality rates from 1981-1983 to 1992 was more pronounced among patients aged over 65 years. One-year survival was 91% and 92% in patients discharged in 1981-1983 and 1992, respectively; however, 1-year after discharge, the survival rate for patients older than 65 years was 85% in 1981-1983 versus 89% in 1992. None of the 5839 patients hospitalized in 1981-1983 received thrombolytic treatment or mechanical revascularization, whereas 46% and 9% of patients received these respective treatments in 1992. CONCLUSIONS: This study suggests that, over the past decade, changes in medical treatment, thrombolytic therapy and mechanical revascularization have significantly contributed to the improvement of the immediate prognosis of patients hospitalized as a result of AMI.

A comprehensive assessment of satisfaction with care: preliminary psychometric analysis in French, Polish, Swedish and Italian oncology patients.

Satisfaction with care may be closely related to quality of life in cancer patients. This evaluation is especially relevant when quality of care is considered. The present study assessed whether equivalent scaling properties could be found in a comprehensive assessment of satisfaction with care (CASC) administered in cancer patients from French, Polish and Swedish oncology settings, in comparison to the scaling properties previously evidenced in the CASC with an Italian sample. A total of 140, 186 and 133 oncology patients were approached in France, Poland and Sweden, respectively. Specific items in the CASC were identified as consistently omitted across country samples. Multitrait scaling analysis on an item-grouping adapted for the French, Polish, Swedish and Italian samples provided excellent internal consistencies and convergent validity estimates. Discriminant validity proved less satisfactory, evidencing overlap between hypothesised care dimensions across country samples. The identification of omitted or overlapping items will lead to the design of a revised CASC version to further test in larger cross-cultural samples.

Oncology nurses' knowledge of graft-versus-host disease in bone marrow transplant patients.

Graft-versus-host disease (GVHD) is a serious complication of allogenic bone marrow transplantation. A descriptive study was conducted to determine oncology nurses' knowledge of GVHD in bone marrow transplant patients. The research question was: Do oncology nurses who participate in continuing education programs and read journal articles on GVHD have increased knowledge, as compared with oncology nurses who do not participate in these activities? Seventy-eight nurses completed a demographic data form and a GVHD questionnaire developed by the investigators (r = 0.71). Multiple regression analysis determined the relationships between independent and dependent variables. An analysis of variance determined a significant difference between the mean scores associated with the identified learning activities (F = 3.61, p less than 0.05). Continuing education activities and reading of journal articles were associated with higher knowledge scores (R2 = 0.1052, p less than 0.05). Many oncology nurses have no formal education in bone marrow transplantation and limited clinical experience with GVHD. Additional work must be done to determine if some oncology nurses practice from a weak theoretical framework and have limited rationales for their nursing actions. Further research, instrument development, and a teaching protocol on GVHD will enhance the nursing care needed by the patient with GVHD.

Continuous SvO2 monitoring. A research review.

Nurses have access to continuous SvO2 monitoring as one parameter for evaluating the hemodynamic status in critically ill patients. The research studies on SvO2 monitoring have demonstrated inconsistent results regarding the utility of SvO2 as an assessment tool. Hence, it is necessary to carefully review these research findings for their impact on nursing practice. Nurses must be aware of the possibility of overreliance on continuous SvO2 monitoring and of the limitations of the SvO2 measurement itself.

[How to improve cancer patients' satisfaction with medical information]. / Comment améliorer la satisfaction des patients sur l'information médicale en cancérologie ?

The medical information becomes integrated into a communications strategy, the generally admitted model of which is centered on the patient; that is in the listening of these concerns and these values. The medical quality information is facilitated by the preliminary collection of the symptoms and the needs of the patients thanks to the questionnaires of quality of life, if they are used during the consultation to direct the discussion. Satisfactory medical information includes a discussion about the questions of the patients in terms of outcomes. Patient's individual factors can influence the need of medical information, as the age and the pathology. Patient's needs can also vary with time and according to the phase of the disease. Cultural factors are essential, in particular as regards the information about prognosis. Tools to help giving the medical information are now validated as the audio cassettes or video. Those tools can take the shape of a prompt list to help patients to ask questions. The majority preference of style of participation in the medical and therapeutic decisions and is the collaborative mode. Physician's attitude is determinant to leave the patients who wish it to have an active role, what allows them a very beneficial feeling psychologically of control over the disease. Decision-making helps are successfully sometimes elaborated to support the participation of the patients. In palliative phase, the need of medical information about prognosis associated with preservation of hope is not still understood by physicians who oscillate between saying the all or none. Honest information at the right time is the majority wish of the patients, although certain patients adopt clearly a strategy of avoidance. The medical communication requires a specific training on this subject. Talking time must be opened to the doctors to approach the relational problems which they meet. The clinical research has to continue to understand better the interactions in doctors/patients communication.

The wandering spleen: CT findings and possible pitfalls in diagnosis.

AIM: To report the CT features of wandering spleen, a rare condition which can be incidentally detected as an abdominal or pelvic mass or can present with torsion, causing an acute abdomen. MATERIALS AND METHODS: The CT studies of seven patients, two children and five adults, with wandering spleen were reviewed. CT was performed urgently in three patients for acute abdomen, and electively in four. RESULTS: CT findings of wandering spleen included absence of the spleen in its normal position and a mass located elsewhere in the abdomen or pelvis, i.e. an ectopic spleen, enhancing homogeneously in four cases and failing partially or completely to enhance in the other three, indicating infarction. A "whirl" appearance representing the twisted splenic pedicle was seen in the three cases with torsion. Urgent splenectomy confirmed infarction secondary to torsion. CONCLUSION: The possible diagnosis of wandering spleen should be kept in mind when CT shows the spleen to be absent from its usual position and a mass is found elsewhere in the abdomen or pelvis. When, in addition, a "whirl" or partial or no enhancement of this mass are seen in a case presenting with acute abdomen, torsion of a wandering spleen is a likely diagnosis.

Extracolonic findings at CT colonography.

This review focuses on the detection of extracolonic findings at CT colonography (CTC). Since its introduction, it has been regarded as a promising alternative to conventional colonoscopy for the detection of colorectal polyps and cancers. Unlike conventional colonoscopy and barium enema, CTC allows evaluation not only of the colon but also visualization of the lung bases, the abdomen, and the pelvis. CTC is performed with thin sections (1-5 mm) and small intervals (0.5-2 mm), enabling superb image reconstruction. The ability to evaluate the extracolonic structures can present a clinical dilemma. On the one hand, CTC may incidentally demonstrate asymptomatic malignant diseases or other clinically important conditions, thus possibly reducing morbidity or mortality. On the other hand, CTC may reveal numerous findings of no clinical relevance; this could result in costly additional diagnostic examinations with an increase in morbidity and overall negative impact on patients' health. In this article, extracolonic findings at CTC will be reviewed and the potential benefits and disadvantages will be presented.