Should patients with a pre-operative prostatespecific antigen greater than 15ng/ml be offered radical prostatectomy?

Background Patients with prostate cancer with a pre-operative prostate-specific antigen (PSA) τ;15ng/ml who undergo radical retropubic prostatectomy (RRP) generally do not have a good outcome, yet may have organ-confined cancer and should be offered the option of surgery. Aim To assess the outcome of patients who underwent RRP with a pre-operative PSA ≥ 15ng/ml. Methods Thirty-four patients, mean pre-operative PSA: 25.46ng/ml (15.03–76.6) and mean Gleason score: 6.4 (5–9) were assessed. Results Two groups were identified. Group I: 41% (14/34) have no biochemical recurrence to mean follow up of 58 months (30–106). Mean PSA: 18.8ng/ml (15.03–25.84). Mean Gleason score: 6.1 (5–7). Clinical stage: T1c in 80%. No patient had seminal vesicle or lymph node involvement. Group II: 59% (20/34) have biochemical recurrence or died (3) from their disease to mean follow up of 66 months (36–98). Mean PSA: 28.9ng/ml (15.28–76.6). Mean Gleason score: 6.7 (5–9). Clinical stage: T1c in 25%. Eleven patients had seminal vesicle (8) involvement or positive lymph nodes (3) or both (2). Conclusion RRP seems feasible in patients whose pre-operative PSA is between 15 and 25ng/ml with stage T1c, Gleason score ≤ 7 and negative lymph node frozen section.     

Teenagers' use of sexual health services: perceived need, knowledge and ability to access

INTRODUCTION: An individual teenager's use of services may depend on perceived need, on knowledge of sexual health and local services, and on ability to access. This paper presents the first UK large-scale quantitative analysis of these factors, comparing those who use services with those who do not. METHODS: 15/16-year-olds (n = 5747) were questioned about their use of sexual health services in the SHARE trial of a school sex education programme in 25 schools in Lothian and Tayside, Scotland, UK. Multilevel statistical models examined the role of different factors on service use. RESULTS: One-third of teenagers had used a service, and use was strongly related to sexual experience. In addition, some family influences and being a school leaver were associated with service use, although we found no evidence for class, ethnic or religious barriers to use. Proximity to specialist clinics was linked with greater use, while low spending money and high parental monitoring were associated with less use. Teenagers with better knowledge, who rated their school sex education as effective, who were comfortable talking about sex and who had discussed contraception with peers were more likely to have used services. Differences in use relating to sexual experience, knowledge, feeling comfortable talking about sex and talking with peers helped to explain gender differences in service uptake. CONCLUSION: There is potential to influence service use through better knowledge and confidence imparted through school sex education, and by improving the links between services and schools.     

Stress buffering effects of family support in AIDS caregiving

This study examines the effects of family support on AIDS caregiver stress over time, comparing HIV-positive and HIV-negative gay-identified men who care for a friend or partner living with HIV (PLWH). Support from the care-recipient's family of origin is assessed, and the stress buffering effects of this type of support are explored longitudinally within a stress proliferation framework for 276 men (114 were HIV-positive, 162 were HIV-negative). Among HIV-positive caregivers, emotional distress is associated with high caregiving stress and low PLWH family support. Emotional distress among HIV-negative caregivers is also associated with caregiving stress, but is not significantly influenced by support from the PLWH's family. For both groups, increasing emotional distress over a seven-month period is a function of increasing caregiver stress, but not PLWH family support. The effects of financial worry and role overload on caregiver emotional distress are conditional upon PLWH family support at Time 1 among HIV-positive caregivers, such that support buffers the distressing impact of financial worry, but may exacerbate the distressing impact of role overload. In addition to characterizing processes of stress proliferation and social support, this research also illustrates how families of choice and families of origin simultaneously shape the experience of the caregiving role and its influence on the wellbeing of gay men.     

Current theories for the development of nonsmoking and nondrinking laryngeal carcinoma

The pivotal risk of smoking and alcohol in laryngeal cancer has meant that evidence for alternate cofactors has been indicative to date. A number of case series, however, contain a few patients who are life-long nondrinkers and nonsmokers and question what other cofactors may contribute. Gastroesophageal reflux disease makes a small but significant contribution to the causal development of laryngeal cancer; however, what remains to be understood is the mechanism of its action. Bile reflux appears to be an additional causative factor in achlorhydrics. After controlling for the effects of alcohol and tobacco, exposure to oncogenic types of human papilloma virus is associated with an increased risk of laryngeal carcinoma. Evidence does not support asbestos exposure itself as increasing the relative risk of laryngeal cancer. A dietary increase in vegetables and fruit may confer an advantage in reducing the laryngeal cancer incidence. Inherited differences in cell cycle control systems, DNA repair systems, and carcinogen-metabolizing enzymes can increase the risk for laryngeal cancer, but as yet, no causal mechanism has been demonstrated.     

Management of common breastfeeding issues

Breastfeeding provides ideal nutrition, growth hormones, and antibodies that change over time as growing infants' and children's needs change and provides these inexpensively, with no harm to the environment. Breastfed infants are healthier than other infants overall, and research indicates that the health benefits may continue on into adulthood. Increasingly, women are choosing to initiate breastfeeding in the hospital, but the attrition starts early and is dramatic. For women to meet their breastfeeding goals, physicians must not only give lip service to "breast is best" but also become knowledgeable in breastfeeding management and actively promote breastfeeding in their practices and in their communities.     

Primary carcinoma of the fallopian tube. A report of 19 cases with literature review

Primary carcinoma of the fallopian tube is the rarest cancer of the female genital tract with an incidence of 0.5% of all gynecologic tumors. Since the first report in 1847 about 1,500 cases have been published. Due to similarity of the clinical presentation the staging and therapeutic management have been adapted to that of ovarian cancer. We retrospectively evaluated all the 19 patients who had been diagnosed with primary carcinoma of the fallopian tube at the Department of Obstetrics and Gynecology of the University of Zurich between 1977 and 1998. All lesions were staged according to the rules of FIGO adopted in 1991. At the time of diagnosis the median age was 62 (46-87) years. Twelve (63%) women revealed FIGO stage III-IV, whereas four (21%) and three (16%) patients were diagnosed in stage I and stage II, respectively. Eight (42%) women were nullipara. Histology showed serous-papillary carcinoma, in ten (53%) cases. The 5-year survival rate was 22% for all FIGO stages and 80% for stage I. None of the patients with stage III and IV survived 5 years. Ovarian cancer and primary carcinoma of the fallopian tube are similar in many aspects. Both carcinomas have a similar age distribution, show an increase among nulliparous women, are often of serous papillary histology, have a poor prognosis with stage and residual tumor size as important prognostic factors, and respond initially well to platinum-based chemotherapy. Nevertheless, there appears to be a difference between the two diseases: primary carcinoma of the fallopian tube is more often diagnosed in an earlier stage. This many be due to lower abdominal pain resulting from tubal dilatation and to abnormal bloody-watery discharge.     

Aborting and Suspending Pregnancy in Rural Tanzania: An Ethnography of Young People's Beliefs and Practices

The World Health Organization estimates that 3.1 percent of East African women aged 15–44 have undergone unsafe abortions. This study presents findings regarding abortion practices and beliefs among adolescents and young adults in Tanzania, where abortion is illegal. From 1999 to 2002, six researchers carried out participant observation in nine villages and conducted group discussions and interviews in three others. Most informants opposed abortion as illegal, immoral, dangerous, or unacceptable without the man's consent, and many reported that ancestral spirits killed women who aborted clan descendants. Nonetheless, abortion was widely, if infrequently, attempted, by ingestion of laundry detergent, chloroquine, ashes, and specific herbs. Most women who attempted abortion were young, single, and desperate. Some succeeded, but they experienced opposition from sexual partners, sexual exploitation by practitioners, serious health problems, social ostracism, and quasi‐legal sanctions. Many informants reported the belief that inopportune pregnancies could be suspended for months or years using traditional medicine. We conclude that improved reproductive health education and services are urgently needed in rural Tanzania.     

The Quality of Young People’s Heterosexual Relationships: A Longitudinal Analysis of Characteristics Shaping Subjective Experience

CONTEXT: Research on young people’s sexual relationships often overlooks subjective experiences and enjoyment. Perceived quality of sexual relationships may be related to gender, background characteristics, circumstances of first intercourse and subsequent sexual history. METHODS: Longitudinal data from 13–16‐year‐olds who participated in randomized trials of school sex education in either Scotland (N=5,356) or England (N=6,269) were used to examine young people’s subjective experiences of heterosexual relationships. Logistic regression models tested for associations between selected variables and pressure and regret at first intercourse, pressure and enjoyment at most recent intercourse, and three measures of relationship quality. RESULTS: Of the 42% of youth who reported having had sex by follow‐up, most assessed their first and most recent sexual relationships positively. Greater proportions of females than of males felt pressure at first sexual intercourse (19% vs. 10%), regretted their first time (38% vs. 20%) and did not enjoy their most recent sex (12% vs. 5%). Younger age at first sex was an important correlate of partner pressure and regret at first intercourse (odds ratios, 2.0 each, for those 13 or younger vs. 15–16‐year‐olds). Negative experiences were associated with less control (e.g., feeling pressure, being drunk or stoned, and not planning sex) and with less intimacy (e.g., sex with a casual partner and less frequent sex). Background social characteristics had limited influence compared with circumstances of first intercourse and subsequent sexual history. CONCLUSION: Most young people evaluated their early sexual experiences positively. The quality of relationships was enhanced by better communication and greater physical intimacy. For a vulnerable minority, however, early sexual experiences were negative. They could be protected by delaying first intercourse, restricting sexual activity to established relationships and learning skills to improve control in sexual encounters.     

Relationship between the chest radiograph, regional lung function studies, exercise tolerance, and clinical condition in cystic fibrosis

This study evaluated the accuracy of the interpretation of the chest film in delineating localised abnormalities of ventilation and perfusion, as well as the overall severity of airways obstruction, exercise tolerance, and clinical condition in children with cystic fibrosis. Radiographic findings in various regions of the chest film were compared with the functional values obtained with regional lung function tests which evaluated the arrival and disappearance of boluses of radioactive nitrogen given by inhalation and infusion. While the more severely affected areas on the chest radiograph were found to correlate with similar regions on the lung function tests, as did overall scores, errors occurred in some cases if the x-ray film alone was used as a judge of regional physiological derangement. In addition the degree of airways obstruction, the exercise tolerance on a cycle ergometer, and clinical grading, each correlated significantly with the radiographic score. We conclude that the chest radiograph is a good indicator of the overall severity of the lung disease and that it correlates well with exercise tolerance and clinical condition in cystic fibrosis.