A study to ascertain gynaecological patients' perceived levels of embarrassment with physical and psychological care given by female and male nurses

Ths sex Discrimination Act lifted the barriers which prevented men from training and practising as midwives. However, cultural attitudes perceive nursing to be a female profession, and whilst care from a male doctor is considered to be acceptable, care from a male nurse is said to be embarrassing. The purpose of the study was to identify if there was any relationship between the intimacy of a nursing interaction and the patient's level of embarrassment. Data collection was by questionnaires with rating scales. Demographic data was obtained from ursing and medical notes. Statistical analysis was performed by non-parametric methods using Mini-tab. Ninety-one questionnaires were returned from a convenience sample of patients on a gynaecological oncology ward. Analysis of the data indicates that in a population of patients who have no prior experience of hospital admission, or of being cared for by a male nurse, there is a preference for care by a female nurse. However, this preference is not demonstrated in patients who have undergone previous hospital admission within the last five years or who have been cared for by a male nurse. These findings would indicate a cultural preference for care by a female nurse in patients with gynaecological cancer that is changed by experience during hospital admission.     

Functional Imaging of Carotid Atheromatous Plaques

Atherosclerotic plaque rupture within the internal carotid artery is an important cause of transient ischemic attack (TIA) and stroke. Conventional imaging techniques such as ultrasound and angiography provide information about the structural consequences of such plaques in terms of luminal stenosis. Most clinical trials of carotid surgery and stenting and based on these imaging methods. Techniques aimed at imaging the biological 'functional' status of the plaque are now emerging. Most of these are based on the premise that inflammatory activity is an index of plaque stability. In this article we review potential imaging targets from the known molecular biological pathways of atherosclerosis. Both conventional imaging techniques and the newer methods are discussed. Recent data from position emission tomography (PET) imaging and from the use of superparamagnetic iron oxide particles with magnetic resonance (MR) imaging are shown.     

T3+ and T4 Rectal Cancer Patients Seem to Benefit From the Addition of Oxaliplatin to the Neoadjuvant Chemoradiation Regimen

Background

To achieve T-downstaging and better resectability in locally advanced rectal cancer, neoadjuvant radiochemotherapy (RCT) has become the current standard of treatment. A variety of schemes have been used. This study investigates which scheme had the best effect on these parameters.

Methods

Our institution is a referral center for locally advanced rectal cancer. Different neoadjuvant radiochemotherapy regimens were administered: long course radiotherapy (RTH), 5-FU and leucovorin (5FUBolus), a combination of capecitabine and oxaliplatin (CORE), and capecitabine only (CAP). Selection of patients for 1 of the regimens was based on hospital policy rather than patient or tumor characteristics.

Results

The data of 504 consecutive patients (n?=?181 T3+, n?=?323 T4) without metastatic disease (cM0) who underwent surgery for advanced rectal carcinoma between 1994 and 2010 were reviewed. The RTH, 5FUBolus, CORE, and CAP scheme were administered to 106, 137, 155, and 106 patients, respectively. Odds ratios for downstaging were less effective for RTH, 5FUBolus, and CAP (0.31, 0.44, and 0.31; P?P?=?.003) or CRM+ resection (3.78, 2.73, 1.34; P?=?.001) were also in favor of the CORE. Hazard ratios for CSS were significantly better for the CORE scheme.

Conclusions

Downstaging with neoadjuvant treatment results in an increased number of radical resections. In our study, the combination of capecitabine and oxaliplatin appears to be the most effective regimen for locally advanced rectal cancer tumors. However, longer follow-up will be necessary to confirm this conclusion.     

Retention of nondeflating balloon in small bowel

Summary Intubation of the upper gastrointestinal tract with balloon catheters has a role in the diagnosis, treatment, and research of many gastrointestinal conditions. A potential complication of this procedure, albeit rare, is failure of the balloon to deflate, thereby preventing removal of the intestinal tube. We describe a case where this problem arose and the series of maneuvers that were attempted to resolve it. Attempts at overdistending the balloon, reaching it via endoscopy, and ultrasound localization of the balloon all failed. The tube was successfully removed following CT-guided percutaneous needle puncture of the impacted balloon. The published experience with nondeflating catheter balloons in hollow viscera has been reviewed and the suggested methods for deflation or puncture are discussed.     

Oral tripotassium-dicitratobismuthate in gastric and duodenal ulceration

One hundred ambulant outpatients with active, endoscopically proven peptic ulceration entered a double-blind trial of either tripotassium-dicitratobismuthate or placebo. Thirty-four patients had gastric ulceration, 56 had duodenal ulceration, three had both gastric and duodenal ulcers, and two had stomal ulceration. Five patients with gastric ulceration were withdrawn from the trial. Three patients with both gastric and duodenal ulceration and two patients with stomal ulceration were excluded from statistical analysis. After 28 days of tripotassium-dicitratobismuthate 94% of gastric ulcer patients had significant endoscopic healing (P less than 0.01). Although 75% of duodenal ulcers healed after 28 days of tripotassium-dicitratobismuthate, this was not statistically significant because of a 60% rate of healing with placebo. Tripotassium-dicitratobismuthate produced a significantly quicker symptomatic response in duodenal ulcer patients (P less than 0.01). No serious side effects were recorded, and patient acceptability was high. It is concluded that tripotassium-dicitratobismuthate is an effective agent for promoting gastric ulcer healing and for symptomatic relief in duodenal ulceration.     

Necrosis of the colon secondary to pancreatitis

Summary This case is the sixth report of colonic necrosis developing secondary to acute pancreatitis. In the previous cases there was no roentgen evidence of colonic inflammation or necrosis prior to surgery or autopsy. The initial radiographic findings in this 56-year-old woman consisted of a diffuse transverse colitis on both abdominal films and a hypaque enema. Subsequent radiographs revealed evidence of a pancreatic abscess and changes consistent with necrosis in the splenic flexure. A contrast enema is recommended in all patients suspected of having colonic manifestations of pancreatitis.Dr. Thompson is a Picker Scholar, James Picker Foundation.     

Abnormal blood vessels in the gastric antrum

Three patients who bled from curious vascular lesions of the gastric antrum are described. Each presented with an iron-deficiency anemia. Histological examination in two of the patients demonstrated numerous ectatic submucosal vessels in the antrum, the appearances being somewhat similar to angiodysplasia of the colon. The gastric lesions were not shown by barium meal examination or angiography but gave characteristic appearances on endoscopy. We believe that Billroth I partial gastrectomy is the treatment of choice for this condition.     

Gallbladder stone recurrence after medical treatment do gallstones recur true to type?

Medical treatments that dissolve or remove gallbladder stones but leave the gallbladder in situ have the disadvantage of gallstone recurrence. Little is known about the composition of recurrent stones or whether they recur true to type. In 21 patients with recurrent stones detected 5–74 months (mean ±sem, 26±4 months) after being rendered stone-free with dissolution therapy (N=15) or percutaneous cholecystolithotomy (N=6), we compared pretreatment and postrecurrence gallstone number, maximum gallstone attenuation scores measured by computed tomography (CT) and, in 13, the dissolvability of the recurrent stones with oral bile acids ± extracorporeal shock-wave lithotripsy. Before treatment, five patients had solitary and 16 had multiple stones but on recurrence, the gallstones differed in number from the primary stones in 10 of the 21 patients. As a result of patient selection, before dissolution, the primary stones were all radiolucent with maximum CT scores of <100 Hounsfield units (HU) (mean 45, range 10–84 HU). On recurrence, the stones were again CT-lucent in 13 of the 15 patients but were CT-dense in the remaining two (118 and 176 HU). Initially, all six patients treated by percutaneous cholecystolithotomy had radio-opaque stones, with a mean CT score of 459 (range 100–969) HU. However, on recurrence, only one had calcified stones (HU 140); the remaining five had CT-lucent stones (16–98 HU,P<0.05). Of the 13 patients whose recurrent, plain x-ray-lucent and CT-lucent stones were treated with oral bile acids ± lithotripsy, 12 (92%) showed evidence of gallstone dissolution. We conclude that gallbladder stones do not recur true to type in up to two thirds of patients. However, irrespective of original gallstone composition, recurrent stones are usually radio- and CT-lucent, presumed cholesterol-rich, and therefore potentially dissolvable with oral bile acids.