Selected complications in neuro-oncology patients.

OBJECTIVES: To identify the causes of and discuss nursing management of those complications that are unique to the brain tumor patient population. DATA SOURCES: Published articles and books related to neurological and nonneurological complications in the neuro-oncology patient. CONCLUSIONS: Seizures, cerebral edema, thromboembolism, and endocrine dysfunction are several complications experienced by the neuro-oncology patient. These complications can be caused by the tumor or treatment of this disease. IMPLICATIONS FOR NURSING PRACTICE: Care of the neuro-oncology patient is complex. Knowledge of the potential complications that patients may experience and how to manage these problems serves to enhance their quality of life.

Links between race/ethnicity and cultural values as mediated by racial/ethnic identity and moderated by gender.

Two studies examined whether individualism (orientation toward one's own welfare), collectivism (orientation toward the welfare of one's larger community), and familism (orientation toward the welfare of one's immediate and extended family) are distinct cultural values predicted by race/ ethnicity. The 3 constructs proved to be separate dimensions, although collectivism and familism were positively correlated. In Study 1, persons of color scored higher on collectivism and familism than did Anglos. No differences emerged for individualism. Also, persons of color scored higher than Anglos on racial/ethnic identity, which in turn was a positive predictor of all 3 cultural values. In Study 2, we replicated the group differences on collectivism and familism for men but not for women.

Issues in metastatic disease.

Because patients with systemic cancer are surviving longer, the incidence of metastatic brain tumors has increased. Currently, studies are investigating alternative radiation regimens. Treatment options of surgery, radiosurgery, brachytherapy, and chemotherapy all provide therapeutic strategies for this patient population.

Differences among various lineages of antigen-presenting cells in processing exogenous antigen internalized through transferrin receptors.

The Ag, pigeon cytochrome c, was coupled to human ferric transferrin by a heteroligation technique to target Ag into the endosomal transport pathway via transferrin receptors. The ability of various types of APC that do or do not express transferrin receptors to process exogenous Ag in their endosomes was investigated by the stimulation of Ag-specific CD4+ T cells with the transferrin-Ag conjugate in a serum-free assay. When two B lymphoma cells were the source of APC, the conjugate was significantly more potent than native Ag in activating the T cells, agreeing with our previous finding using a third B lymphoma cell. The conjugate and Ag were similarly presented by splenic B cells that lack transferrin receptors to the T cells. However, both a macrophage hybridoma and a MHC class II-L cell transfectant hardly elicited a T cell response to the conjugate, although a response to native Ag was readily observed. These findings could not be attributed to an absence of transferrin receptors or receptor-mediated internalization of the conjugate, nor to differential expression of MHC class II molecules or li chain by the APC. The poor presentation of the conjugate by the L cell transfectants was associated with diminished catabolism of the conjugate, however, the macrophage hybridoma rapidly degraded the conjugate, similar to the B lymphoma cell. Peritoneal macrophages, which lack transferrin receptors, and the macrophage hybridoma induced a response to the conjugate only at concentrations that allowed internalization by fluid phase pinocytosis. The lower potency of the conjugate compared with native Ag with non-B-presenting cells suggest that these cell types process the conjugate by a different mechanism than used by B cells. Differences in the mechanism of Ag processing used by APC of distinct cell lineages may possibly influence immune responsiveness.

Dipyridamole-thallium myocardial scanning in the preoperative assessment of patients undergoing abdominal aortic aneurysmectomy.

Dipyridamole thallium scanning (DTS) is an imaging technique with good sensitivity for coronary artery disease (CAD). The purpose of this study was to compare the haemodynamic courses and the correlation between pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP) in patients with normal DTS (Group 1: n = 12) with those whose scans demonstrated CAD (Group 2: n = 11). Haemodynamic profiles were obtained prior to anaesthesia and at several times during surgery. The haemodynamic courses in both groups were similar with significant decreases in cardiac index, stroke index, and left ventricular stroke work index during aortic cross-clamping compared with values prior to anaesthesia. There were no significant changes in PCWP and CVP throughout the study. The correlations between PCWP and CVP were significant in both groups as were the correlations between the changes in PCWP and the changes in CVP observed at the time of cross-clamping. These correlations all had large standard errors of the estimate, however, making it impossible to predict the PCWP from the CVP with precision. It is concluded that, in a limited study population, an abnormal DTS did not identify patients in whom the PCWP and CVP correlated poorly during abdominal aortic aneurysmectomy.

The suppression of exciting thoughts.

We examined how the suppression of an exciting thought influences sympathetic arousal as indexed by skin conductance level (SCL). Subjects were asked to think aloud as they followed instructions to think about or not to think about various topics. Experiment 1 showed that trying not to think about sex, like thinking about sex, elevates SCL in comparison to thinking about or not thinking about less exciting topics (e.g., dancing). Experiment 2 revealed that the suppression of the thought of sex yielded SCL elevation whether or not subjects believed their think-aloud reports would be private or public, and it also revealed that the effect dissipated over the course of a few minutes. Experiment 3 found such dissipation again but showed that subsequent intrusions of the suppressed exciting thought are associated with further elevations in SCL over 30 min. Because such an association was not found when subjects were trying to think about the exciting thought, it was suggested that the suppression of exciting thoughts might be involved in the production of chronic emotional responses such as phobias and obsessive preoccupations.

Empathy levels of occupational therapy students.

Certain levels of empathy are vital to health professionals for understanding their patients. The Level I clinical practicum experienced by Ohio State University juniors did not have the anticipated impact upon their empathy scores, but a group process course, where it was possible to teach and evaluate empathy levels, might have positively affected the empathy levels of students.