[Principles of larynx surgery and nurse surveillance]. / Principes de la chirurgie du larynx et surveillance infirmière.

Endoscopic transoral surgical techniques have developed, adapted to forms of early stage larynx cancer. A total laryngectomy remains the only treatment for patients suffering from an advanced stage cancer which is not receptive to organ preservation strategies. For all these patients, nurse surveillance combines technical and relational care.

Relieving the pain of sentinel lymph node biopsy tracer injection.

Sentinel lymph node biopsy (SLNB) has been reliably accurate as a minimally invasive surgical alternative for identifying lymphatic breast metastasis. During mapping, the injection of a radioactive tracer or isosulfan blue dye to differentiate the SLN is acutely painful. The use of the eutectic mixture of lidocaine and prilocaine (EMLA) cream to reduce tracer injection pain has been reported anecdotally. A retrospective study compared injection discomfort of 20 women who had undergone SLNB without EMLA and 20 women who had undergone SLNB with the EMLA protocol. Results indicated a significant difference in mean pain rating. Standards of care should include the use of EMLA prior to intradermal SLN tracer injection unless contraindicated.

Lymphatic mapping and sentinel lymph node biopsy.

Malignant melanoma--cancer of the pigment cells--has the highest mortality rate of all skin cancers. With early detection and treatment, however, malignant melanoma is highly curable. Recently, diagnostic modalities for nodal involvement have been perfected, reducing the morbidity of elective lymph node dissections and rendering them unnecessary in many cases. Total lymphadenectomy procedures are being replaced by intraoperative lymphatic mapping and sentinel lymph node biopsy using gamma detector probes. This article reviews lymphatic drainage from the primary site to possible lymph node basins and selective lymph node dissection using lymphoscintigraphy and intraoperative mapping as guides. This article also includes a case study, beginning with a diagnosis of malignant melanoma and following a successful postoperative course.

Role of the stoma care nurse: patients with cancer and colostomy.

This case study describes the physical, psychological and emotional problems of a female patient suffering from rectal cancer, who required the formation of a colostomy. It highlights the role of the stoma care nurse from diagnosis, though staging of the disease, to treatment and recovery in hospital and at home, and discusses the problems of altered body image and the need for effective communication to enable the patient to achieve a good quality of life.

Lymphatic mapping and sentinel node biopsy. New technology for women's health.

The current surgical standard of care for the management of invasive breast cancer is the complete removal of the cancer with documented negative margins by either mastectomy or lumpectomy followed by complete axillary lymph node dissection. These procedures can be associated with significant morbidity which leads to increased hospitalizations, increased overall costs and considerable discomfort and life-style changes for the patients. With sentinel node identification and biopsy, patients with probable negative lymph nodes may avoid axillary dissection, and easily be treated as outpatients.

Pathology of genitourinary malignancies: implications for clinical management.

OBJECTIVES: To describe the pathologic and molecular characteristics of genitourinary malignancies relevant to the implications for the practice of oncology nurses. DATA SOURCES: Actual cases from the author's clinical experience, original scientific papers, review articles, and pathology books. CONCLUSION: Accurate pathologic diagnosis and identification of serum and molecular markers are critical for the accurate classification, staging, and choice of appropriate treatment for patients with genitourinary malignancies. IMPLICATIONS FOR NURSING PRACTICE: Because decisions of treatment initiation, discontinuation, and prognosis are in large part based on pathologic diagnosis and staging, oncology nurses should be knowledgeable about the process of pathologic tissue review and understand the importance of appropriate tumor acquisition.

Looking at lymphoma and leukemia.

Learn the signs and symptoms of these liquid tumors and how to help patients manage them.

Factors related to persistent fatigue following completion of breast cancer treatment.

PURPOSE/OBJECTIVES: To verify the predictive capacity of the stress-process theory to emeanplain persistent fatigue following completion of breast cancer treatments; to verify the relationship between interleukin-1b and fatigue. DESIGN: Correlational. SETTING: Tertiary medical center in Quebec City, Canada. SAMPLE: A systematic sample of 103 women in remission from breast cancer was recruited. The mean age was 54 years. Participants with a depressive mood, insomnia, or stage IV cancer were emeancluded. METHODS: Participants were met during their follow-up appointment after the end of radiation therapy. Questionnaires on fatigue, stress variables, and other confounding variables were completed by telephone interview. Blood samples also were collected to measure the serum level of interleukin-1b. MAIN RESEARCH VARIABLES: Fatigue, several variables from the stress-process theory, pain, menopausal symptoms, and demographic and medical variables. FINDINGS: Fatigue was related theoretically and coherently to many stress-process variables. By controlling for pain, the final regression model included cancer stressors and passive and active coping as predictors, which accounted for 41% of the variance in fatigue. No relationship was found between fatigue and interleukin-1b. CONCLUSIONS: The results supported the relevance of the stress-process theory for emeanplaining cancer-related fatigue. IMPLICATIONS FOR NURSING: Nursing interventions based on this theoretical framework could be developed. In addition, further clinical research that tests the efficacy of these psycho-educative interventions in preventing persistent fatigue and improving the quality of life of women with breast cancer is recommended.

The effects of concrete objective information and relaxation on maintaining usual activity during radiation therapy.

PURPOSE/OBJECTIVES: To examine the effects of concrete objective information (COI) and relaxation instruction (RI) on patients undergoing radiation therapy, as well as the contribution of symptom uncertainty and body awareness to the intervention effects. DESIGN: Three-group randomized trial. Assignment was stratified by cancer site. Data collectors were blinded to group assignments. SETTING: University medical center radiation therapy department serving both urban and rural communities in the southeastern United States. SAMPLE: 76 adults having radiation with curative intent for gynecologic, head and neck, or lung cancer. Most were Caucasian and had in situ to stage II disease. Mean age was 55 years. METHODS: COI and RI were delivered by tape recordings. Outcome measures were indicators of usual activities and emotions at treatment week 3 and two and four weeks post-treatment. MAIN RESEARCH VARIABLES: Intervention group; social, household, and recreational activities; anxiety, depression, and anger; body awareness; and symptom uncertainty. FINDINGS: Participants receiving either intervention reported more social activity during treatment. Those given RI who were high in body awareness reported more household activity during treatment. No effects were found regarding emotion. Symptom uncertainty partially explained COI effects. CONCLUSIONS: The findings provide additional support for the effectiveness of COI in helping patients to maintain more of their usual activities during radiation therapy. Instruction in progressive muscle relaxation also may help in maintaining activities. IMPLICATIONS FOR NURSING: COI helps patients to cope with treatment by reducing their uncertainty about symptoms. RI effects may vary by activity type and awareness of usual body sensations.