Relating information needs to the cancer experience. 2. Themes from six cancer narratives

Many different issues may arise for individuals with cancer, where the provision of information can be an effective coping strategy. It is also clear that information needs change over time and vary from person to person. This paper considers six cancer narratives from a study seeking to identify the information needs of people with cancer that emerged out of their cancer experience. Six respondents were invited to tell their story through in-depth interviews and narrative analysis uncovered thematic aspects of the lived experience. Themes emerged which showed that cancer impacts on different aspects of an individual's self-identity, including body image, family, social and work relationships. Cancer was viewed as an intrusion and the illness engendered feelings of vulnerability that impacted on their normal coping mechanisms. This resulted in a decreased ability to process information. While individuals expressed medical information needs, they were less likely to articulate their need for information when it related to other areas of their lives. Individuals reached a turning point during their experience, when the self-acknowledgement that they were living with cancer, enabled them to become more active respondents in the information process. As this stage cannot readily be identified as occurring at a specific point of the cancer trajectory, communication channels need to be kept open regarding information-giving. This raises questions about areas for further study.     

Effects of Oestrogens and FSH on LH Stimulation of Steroid Production by Testis Leydig Cells from Immature Rats

Hypophysectomy of immature male rats results after 5 days in a decreased production of testosterone by isolated testis Leydig cells in response to LH. The LH responsiveness of the Leydig cells can be partly restored by treatment of the hypophysectomized rats with FSH. In continuation of previous reports on this subject ( Steroids 28 (1976) 847; and 30 (1978) the following conclusions were derived from the results in the present paper:
1. After hypophysectomy of immature male rats the production of testosterone (T) as well as of 5-pregnenolone (Δ5P) by isolated Leydig cells in response to LH is reduced.
2. Daily administration of FSH after hypophysectomy restores the Δ5P production in response to LH almost completely, but has a much smaller effect on the restoration of T production.
3. Administration of oestradiol benzoate (E₂B) together with FSH has no effect on the restoration of LH-stimulated Δ5P production, but causes a reduction of T production, when compared with Leydig cells from animals treated with FSH only.
4. Treatment of intact immature rats with E₂B results in a decreased production of T and an increased production of Δ5P in isolated Leydig cells.
5. From experiments with labelled pregnenolone it appears that E₂B and diethylstilboestrol (DES) inhibit the 17α-hydroxylase activity of Leydig cells from intact as well as from hypophysectomized rats. This results in a reduced conversion of pregnenolone to C1:)-steroids and in increased production of 3α-hydroxy-5α-pregnan-20-one from δ5P.
6. The observed effects of FSH and E, were similar within a dose range of 100–10000 ng LH per 106 Leydig cells.     

Peripheral embolism resulting from unsuspected atheromatous aortic plaques.

Three cases of peripheral embolism resulting from atheromatous aortic plaques are reported. Although the majority of arterial thromboemboli are believed to have originated from mural thrombi within one of the cardiac chambers, there is reason to believe that embolism from atheromatous material within a major artery may occur more often than is represented in current literature. Successful management of this condition will necessitate (1) clinical awareness, (2) careful scrutinization of material recovered from embolectomy, (3) angiography to demonstrate the embolic source in the aorta or its main braches, and (4) appropriate remedy by either endarterectomy or graft replacement of the diseased artery segment. The pitfalls in the diagnosis of this condition are discussed.     

Flow cytometry of fine-needle-aspiration biopsies: a new method to monitor the intrahepatic immunological environment in chronic viral hepatitis

SUMMARY: Information about the character and grade of the intrahepatic immune response in viral hepatitis is important for the evaluation of disease stage and effect of therapy. Complications like haemorrhage limit the frequent performance of tissue-needle biopsies (TB), and the cells of peripheral blood have to be used as surrogate markers instead. Fine-needle-aspiration biopsy (FNAB) of the liver represents a safe and atraumatic method that allows frequent cytological sampling. Our aim was to investigate whether flow cytometry of FNAB specimens allows co-analysis of phenotype, function and specificity of key populations of liver-infiltrating lymphocytes (LIL). In 20 consecutive patients with chronic viral hepatitis [10 hepatitis B virus (HBV), 10 hepatitis C virus (HCV)], flow cytometry was performed on FNAB cytology, and simultaneously on lymphocytes isolated from a TB and peripheral blood mononuclear cells (PBMC). The ratio of CD8+/CD4+ lymphocytes in FNAB correlated well with LIL from TB (r =0.78, P < 0.05) but differed from PBMC (mean ratio: 2.6, 2.1 and 0.7, respectively). Similarly, a correlation was observed for percentage CD56+ natural killer (NK) cells (mean %: 29.9, 32.3 and 14.5, respectively; r = 0.69, P < 0.05). The percentage of interferon (IFN)-gamma-producing CD3+ lymphocytes in both FNAB and TB was higher than in PBMC (mean %: 41, 44 and 22, respectively; P < 0.05). Furthermore, tetrameric complexes allowed analysis of HBV-specific T cells in FNAB specimens. In conclusion, flow cytometry of FNAB allows easy, atraumatic and reliable analysis of lymphocytes obtained from the intrahepatic compartment. Therefore, the FNAB is a valuable tool in the study of the immunopathology of viral hepatitis, and it may contribute to the improved clinical evaluation of chronic viral liver disease.     

Cognitive performance in patients with COPD

BACKGROUND: Hypoxemic patients with Chronic Obstructive Pulmonary Disease (COPD) have impaired cognitive performance. These neuropsychological impairments are related to the degree of hypoxemia. So far, cognitive performance has not been tested in non-hypoxemic patients with COPD. METHODS: We recruited patients with stable COPD and PaO2 > 8.0 kPa (60 mmHg), as well as healthy subjects, who were matched for age, intelligence quotient (IQ), and level of education. Cognitive performance was studied by Stroop Colour Word Test, Trailmaking, digit-symbol of the Wechsler Adult Intelligence Scale, addition subtest of the Groningen Intelligence Test, and Story Recall. RESULTS: Thirty patients with COPD (FEV1 49.8% pred, mean age 64.8 yr) and 20 healthy volunteers (65.6 yr) were enrolled. COPD patients performed significantly worse on trailmaking B, the digit-symbol test, and on the addition subtest. There was no significant correlation between the tests of cognitive performance and disease specific health status (Chronic Respiratory Questionnaire). CONCLUSIONS: We conclude that even non-hypoxemic patients with COPD show significant impairments in cognitive performance. These impairments are not associated with deteriorations in health related quality of life. Prospective evaluation of the impact of treatment on cognitive performance in non-hypoxemic patients with COPD would be a logical subsequent study.     

Vagal function in health and disease: studies in Pittsburgh

The integration of behavioral processes with changes in vagally-controlled heart rate has been the focus of our investigations. A series of studies is reviewed showing that central and peripheral response inhibition is a primary source of transient, vagally-induced cardiac slowing during information processing. Individual differences in such responses are then shown to relate to the amplitude of cardiovascular responses to stressors. Overall, the specificity and sensitivity of vagal responses to higher level cortical function is supported by our research.     

Reduction of patient motion artifacts in digital subtraction angiography: evaluation of a fast and fully automatic technique

The performance of an automatic technique for the reduction of patient motion artifacts in digital subtraction angiography was evaluated. Four observers assessed the quality of 104 cerebral digital subtraction angiographic images that were processed by means of both the automatic technique and manual pixel shifting. The automatic technique resulted in better image quality and was considerably less time-consuming.     

Clinical and experimental white atrophy

The author was, in 1952, the first to draw attention to the possibilities of revascularization of white atrophy. The data which he produced in 1952 have remained correct. Time has amply confirmed them and so, using these data, the author studies the nature of revascularization; he underlines the very important idea following the experiments carried out by Boersma, of rhythmical jarring in the return venous circulation, both superficial and deep, and shows how it is possible to counteract the ill-effects of these veritable battering-ram shocks by means of ambulatory compression perfectly applied. The more the compression offers resistance to the jarring during walking, the more limited the risk of relapse will be. A patient who carefully follows the prescribed treatment has a good chance that the development of the disease will not be crowned by relapse.