Stress and quality of life in patients with gastrointestinal cancer.

This study aimed to answer the question whether it is possible to predict the quality of life in individuals with gastrointestinal cancer based on the number of life events, perceived stress levels and coping strategies. The study included 60 individuals (44 male and 16 female) aged 48 to 87 years, with malignant gastrointestinal tract diseases (56 with colon or rectal cancer, 2 with stomach cancer and 2 with pancreatic cancer). The following instruments were used: Questionnaire on General Information and Lifestyle Habits (developed for the purpose of this study); Scale for Measuring Quality of Life; Coping Inventory for Stressful Situations; and Life Events Scale. Results showed that the number of life events, perceived stress levels, emotion-oriented coping and avoidance were not predictive for the quality of life. Education was the only predictor for factors contributing to the quality of life (predictive variables on the Scale for Measuring Quality of Life). Task-oriented coping and education were predictors for satisfaction with past life and task-oriented coping was predictive for criterion variables on the Scale for Measuring Quality of Life and for factor related to future expectations and comparison to other people, but the proportion of explained variance was modest. The results of this study suggest that it is important to consider other variables (e.g., personality traits and sociodemographic factors) in predicting the quality of life and psychotherapeutic work with gastrointestinal cancer patients. It is important to bear in mind that there is no universally good individual coping strategy that is acceptable in all situations, but that coping flexibility or the ability to adequately change coping strategies in response to situational demands is by far more important.

Ultrasonic investigation of parametric values of portal vein diameter in healthy subjects and patients with chronic diffuse liver disease.

INTRODUCTION: Portal vein in healthy subjects and in patient with chronic diffuse liver disease was investigated by the combination of real-time technique and Doppler impulsive system. PATIENTS AND METHODS: Control group consisted of 99 healthy subjects of median age of 36,8, and with life raging span from 14 to 77 yrs. Experimental group consisted of 55 patients with histologically proved liver disease approximately aged 48,1 yrs. And with life span from 11 to 77 yrs. In 15 patients, portal hypertension was proved, by the measurement of Wedged hepatic venous pressure (WXVP). RESULTS: VP diameter was normally distributed in healthy subjects, variable with E(X) = 11,202 mm and SD = 1, 2534. The mentioned variable was also normally distributed in experimental group with E(X) = 10, 8 mm and SD = 1, 4832. VP diameter in healthy subjects did not statistically significantly differ from that one of the patient with chronic diffuse liver disease, which in contradictory to the generally accepted concepts. According to our results, portal vein diameter should not be taken as a parameter of portal hypertension.

Quality of life and personality traits in patients with colorectal cancer.

BACKGROUND: The aim of this study was to determine whether it is possible to predict quality of life in patients with colorectal cancer on the basis of personality dimensions from the Five-factor model. SUBJECTS AND METHODS: The study included 56 patients with colorectal cancer (40 men and 16 women), aged 48-87. The following instruments were used: the Questionnaire on General Information and Lifestyle Habits, the Quality of Life Scale, and the Neo Five-Factor Inventory. RESULTS: The results of overall quality of life estimations of colorectal cancer patients were comparable to those of healthy people. Contrary to expectations, extraversion was not a significant quality of life predictor. Neuroticism as a personality trait was the only variable which consistently proved to be highly significant across analyses in the prediction of total quality of life, satisfaction with past life, future expectations, and comparison with others. Key determinants of neuroticism are a proneness to experiencing negative affects which makes adaptation difficult, a proneness to irrational ideas, reduced impulse control, ineffective coping strategies, the perception of poor control over oneself and others, and deeming one's own resources to be insufficient to adequately cope with stress, thus resulting in a more negative quality of life estimation. CONCLUSION: These results support the conclusion that cognitive-behavioral interventions aimed at changing negative attributions, reducing tension and negative affects, acquiring more effective coping strategies, strengthening perceived personal control, redefining and re-conceptualizing quality of life, and seeking/receiving more adequate social support could lead to an improved quality of life in patients with colorectal cancer.

Repeated administration of inhibitors for ion pumps reduce markedly tumor growth in vivo.

INTRODUCTION: Measurements of extracellular pH show that the micro environment of malignant tumors is more acidic than that of normal cells, whereas pH does not differ appreciable in normal and malignant cells. The acid micro environment of tumors is created by the secretion of tumor factors and ATP hydrolysis in hypoxic tumor tissue. In order to survive in a low pH-environment tumor cells develop regulatory mechanisms which keep their intracellular pH stable. Two of the most important systems are the Na+/H+ ion pump and the Na-dependent HCO3-/Cl- pump of stilbenian derivatives. MATERIAL AND METHODS: Experiments were carried out on DBA mice of both sexes at the age of 4 month. Laboratory animals were grown in our institute and supplied with food and aqua ad libitum. RESULTS: After termination of the experiments the mean tumor diameter in the control group was 12.4 +/- 0.8mm, in group A it was 6.9 +/- 0.6mm, and in group B we measured 6.6 +/- 3.1mm. At the final day the tumor size in treated animals was twice as small as in the control group. In addition we observed the rate of survival. In the control group only 18% of the animals were still alive at day 18. Considering the rate of survival a statistically significant difference between treated and untreated animals was observed. The survival of tumor cells is dependent on the function of these ion pumps which keep their intracellular pH values constant in the setting of an acid extracellular environment. CONCLUSION: The activity of the ion pump is especially important at the beginning of cell division and in cell proliferation. Our in vivo experiments demonstrate that prolonged administration of intratumoral ion pump inhibitors suppresses tumor growth as well as enhances survival of tumor-bearing animals. Research of inhibitors of ion pumps and their action in tumor growth opens new perspectives into pathophysiology of malignant tumors and may create new therapeutic options.

The use of piezoelectric effect to improve instrument quality and patient safety in laparoscopic surgery.

The piezoelectric properties of some natural crystals and polymers can also be used in surgery. For this purpose, a prototype of an endoscopic instrument was constructed with piezoelectric material attached to its working end with the aim of recognizing pulsating blood vessels during laparoscopic surgery. To test the properties of the new instrument in laboratory conditions, simulated blood circulation was used with the possibility of changing pressure and frequency. The instrument was tested in the pressure range of 40-180 mm Hg at constant frequency of 72/min and frequency range of 36-130 beats per minute at constant pressure of 120 mm Hg. Test results showed that the instrument with certainty recognized a pulsating "blood vessel" in the expected pressure ranges and at different blood pump frequencies. Given the piezoelectric material's very small dimensions and flexible form, it can be installed at the working end of most standard laparoscopic instruments and thus significantly increase certainty in the recognition of arteries during surgery, which would reduce the possibility of their injury or accidental ligation.

Pregnancy and vaginal delivery in epidural analgesia in woman with cerebrospinal fluid shunt.

Hydrocephalus is a medical condition characterized by enlargement of cerebral ventricles due to abnormal cerebrospinal fluid accumulation. Hydrocephalic women with cerebrospinal fluid (CSF) shunts are now surviving to reproductive age, but still there are doubts regarding the mode of delivery, analgesia and anesthesia. Postpartal complications are more frequently described in deliveries ended by cesarean section than in spontaneous vaginal deliveries. We present a case of labor in the 32-year old woman, with congenital hydrocephalus and a preexisting ventriculoperitoneal (VP) shunt. After thorough review of current literature, we came to conclusion that without absolute neurosurgical indication or acute development of listed symptoms (headaches, irritability, light sensitivity, hyperesthesia nausea, vomiting, vertigo, migraines, seizures, weakness in the arms or legs, strabismus and double vision) the best way to finish the pregnancy of woman with VP shunt is spontaneous vaginal delivery with the use of epidural analgesia, mediolateral episiotomy and vacuum extraction.

Microdochectomy in the management of pathologic nipple discharge.

BACKGROUND: There is a debate in the literature whether a pathologic nipple discharge is a distinct sign of breast carcinoma. Our own results obtained by the use of microdochectomy as a minimally invasive operative procedure in 184 patients with pathologic nipple discharge were analysed. The aim of this retrospective 20-year study was to assess the efficacy of microdochectomy in detecting early stages of intraductal breast carcinoma. PATIENTS AND METHODS: The study included data on 184 patients aged 24-77 years (median 46.6) divided into two groups of premenopausal (n = 123) and postmenopausal (n = 61) women. There were 139 patients with unilateral single-duct sanguinolent discharge and 45 patients with other types of nipple discharge. The operative procedure consisted of the discharging duct excision by use of a guide probe, preceded by cytology and ductography studies. RESULTS: Histopathology of the excised ducts revealed only three carcinomas in premenopausal women and ten carcinomas in postmenopausal women. In a total of 13 carcinomas, there were 4 ductal carcinomas in situ, detected in patients aged 41-72 (median 66) years. Twelve carcinomas were associated with sanguinolent nipple discharge. Papilloma was the most common histology finding (56.5%). CONCLUSION: Results of the study suggested mainly the association of sanguinolent single-duct nipple discharge and papilloma, whereas the rate of malignancies detected (7.0%) was consistent with literature reports. Microdochectomy proved to be a highly efficient operative method free from any impairment of the breast integrity. Conservative treatment with close clinical monitoring of the patient with cytology and ultrasonographic assessment might be possible in selected cases.

Effect of pesticides on wound contraction.

Agricultural injuries are a complex surgical problem, especially because of frequently extensive skin lesions prone to infection and delayed healing. The aim of the study was to assess the local effect of pesticides, chemical substances widely used in agriculture, on wound healing, especially on wound contraction. Local effects of the combined herbicide composed of atrazine and dual (Primextra) and insecticide alphametrin (Fastac 10% SC) on primary wound healing were assessed in a bioassay performed in 18 New Zealand white rabbits. Relative size of the wound, measured on days 0, 1, 3, 6, 9 and 12 of wounding was analyzed by two-factor analysis of variance with repeat measurements. The activity of the process of restoration was assessed on histopathologic preparations obtained after the last measurement. Results of the study showed the final wound contraction to be smaller and the process of healing slower in the experimental groups of animals. Histopathology revealed defects of epithelialization, phasic delay in healing, infiltration with eosinophilic granulocytes, and decreased density of newly formed collagen. Pesticides were concluded to have adverse local effects on the wound, causing impairment of the mechanisms of healing.

The immunomodulation effect of allogenic blood transfusion in colorectal cancer--a new approach.

The total number of 542 patients with colorectal cancer surgery have been analyzed in order to estimate the effect of receiving transfusion local recurrences, and the disease free - survival. It should be examined whether there are changes in general immunity indicators which would be connected with perioperative transfusion. A significant connection has been found between local recurrences and blood transfusion (p<0.0001), the most noticeable being in Dukes A (p =0.045), localization on rectum (p=0.036). The receiving of blood transfusion is linked significantly with disease free - survival reduction (p =0.0068; log rank), the most significant being in Dukes A stage (p =0.0123; log rank) and with localization on rectum (p=0.0231). The analysis of general immunity indicators has shown significant immunocompromitation of patients just before the surgery and this could have effect on immunomodulation caused by transfusion and just as on the treatment prognosis of colorectal carcinoma.

[Comparison of open and laparoscopic cholecystectomy in the treatment of acute cholecystitis]. / Usporedba otvorene i laparoskopske kolecistektomije u lijecenju akutnog kolecistitisa.

The paper analyses and compares the results of the treatment of acute cholecystitis with open and laparoscopic approach in a seven-year period. From 1994 to 2000, 311 patients with clinical picture of acute cholecystitis were operated. Open cholecystectomy was done in 162 (52.09%) patients, and laparoscopy in 149 (47.91%). In both patient groups the time from the onset of clinical symptoms to the surgery, and preoperative workup and preparation, were the same. In patients with open surgery the procedure lasted 93 (+/-SD) minutes, and in those with laparoscopic surgery 114 (+/-SD) minutes. Those operated with open method received 5.83 (+/-SD) ampules and 3.75 (+/-SD) tablets of analgesics, and those with laparoscopic surgery 3.2 (+/-SD) ampules and 2.1 (+/-SD) tablets per patient. Antibiotics were administered to 149 patients with open surgery for 4.9 (+/-SD) days and to 68 of those with laparoscopic surgery for 2.29 (+/-SD) days. Patients with open surgery stayed in the hospital 9.55 (+/-SD) days and were on sick leave 43 (+/-SD) days, and those with laparoscopy spent 4.35 (+/-SD) days in hospital and were 16 (+/-SD) days on sick leave. In conclusion, better clinical results and faster return to everyday activities point to the significant advantage of laparoscopic cholecystectomy. Analysis of the results shows that total costs of treatment of working patients are significantly lower than of those with laparoscopic surgery, due to shorter hospital stay, shorter sick leave, and faster recovery.