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.     

Music,Musicians, Medicine,and the Kidney

The relationship between music, medicine and nephrology is ancient; ranging from musicians afflicted with kidney disease, contributors to nephrology who were musicians, and the use of music to treat renal maladies. Musicians have long been afflicted by diseases of the kidney, particularly nephrolithiasis, for which Marin Marais in 1725 composed a unique piece for the viol detailing the harrowing experience of ‘cutting for stone.’ Beethoven and Mozart were afflicted by kidney disease, as are several current musicians. Where past musicians succumbed to their failing kidneys, the advent of renal replacement therapy has given today's musicians, such as James DePreist and Natalie Cole, the opportunity to continue performing and composing. Several notable physicians of old have excelled as musicians; one example is Jacob Henle (1809–1885), for whom the loop of Henle is named, another is Robert Christison, a contemporary of Richard Bright, who is considered a ‘founder of nephrology’. Importantly, music therapy, as used in the times of Hippocrates and King David, has evolved from an empiric to a well‐established scientific discipline. Given the recent enlarging body of scholarly studies of music therapy, its rudimentary role in nephrology deserves further exploration.     

Decency, honor, integrity, and the law

In its guidelines for hand care professionals, the American Society for Surgery of the Hand has set the following criteria as guidelines for the ethical hand surgeon in the 21st century: decency, honor, and integrity. This article reviews these criteria in detail, relates how they apply in practice, and describes how they interact with state and federal law in both legislative and judicial aspects. Matters pertaining to informed consent, privacy issues, patient autonomy, shared decision making, and conflict of interest are described, and recent developments in this area are examined. Are hand surgeons ready for an enforceable system of ethics to be handed down by the ASSH or by the government?     

Anesthesia,the aging brain,and the surgical patient

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -