Prostate cancer, the urologist, the patient, and treatment

Prostate cancer, particularly advanced prostate cancer, should be considered as a chronic disease that requires multidisciplinary management. Each health professional involved the urologist of course, but also the other therapists, especially the general practitioner and nurse, should place their activities within a therapeutic synergy. The onco-psychological dimension should not be underestimated. In particular, information about the disease, its course and the therapeutic solutions proposed should be given gradually and, above all, should be regularly recapitulated. Patients are more accepting of treatments when they know about them. The point of view of the patient with prostate cancer is approached here in two ways; firstly through the comments of a psychologist on the history of a patient with prostate cancer and the dialogue with an experienced urologist. The treatment should not only be understood, but also accepted and requested by the patient. In this chronic disease, the patient often feels the treatment to be a bond between the therapist and himself. A survey based on an auto-questionnaire was also conducted among 275 patients and 50 urologists in order to investigate these relationships. From the results of this survey, in the case of hormone treatment, a quarterly rhythm for LHRH agonist injections appears to be perfectly matched to patient requirements. Monthly injections involve too great an intrusion by the treatment into the life of a cancer patient, in contrast injections which are spaced at greater than quarterly intervals could be seen to much as desertion and also lead to forgetfulness and neglect.     

Linking the Disabilities of Arm, Shoulder, and Hand to the International Classification of Functioning, Disability, and Health.

The objective of this study was to explore whether the items from a specific outcome measure, that is, Disabilities of the Arm, Shoulder, and Hand (DASH), for quantifying limb symptoms and functions in musculoskeletal disorders fit into the framework of the International Classification of Functioning, Disability and Health (ICF). All DASH items were compared to the ICF according to eight linking rules. Two groups of researchers performed the linking independently, and the results were compared by correlation. The 30 DASH items and four items from the optional modules were linked to 63 ICF categories and 11 chapters: 15 categories belong to the ICF body functions component and 48 to the activities and participation component. There were no items coded under the components body structure or environmental factors. Kappa index showed an agreement of 0.73 (p<0.001). The results showed that the content of the DASH does link well with the ICF framework. Clinicians and researchers must attend to the fact that certain domains and categories from the ICF are not covered by the DASH. Limitations of the instrument may be overcome by simultaneously using other instruments that address the intended content.     

Priestley, the furious free thinker of the enlightenment, and Scheele, the taciturn apothecary of Uppsala

'The more elaborate our means of communication, the less we communicate'.
Joseph Priestley     

Anatomy of the caecum,appendix, and colon

The large intestine comprises the caecum and appendix, colon, rectum, and anal canal from proximal to distal. Embryologically, the proximal half of the large intestine is derived from the midgut, while the distal half develops from the hindgut. This dual derivation is reflected in the difference in arterial supply to its proximal (superior mesenteric artery) and distal (inferior mesenteric artery) portions. Physiologically, the large intestine primarily functions to absorb water and essential electrolytes (sodium and chloride) from its luminal contents leaving the unabsorbed residue to be excreted as faeces. Fibre-optic colonoscopy and MRI and CT colonography allow detailed internal inspection of the large intestine with relative ease and with minimal discomfort. This article highlights the clinically and surgically relevant aspects of the anatomy of the caecum, appendix, and colon.