Assessment of preoperative anxiety: comparison of measures in patients awaiting surgery for breast cancer

We have compared three measurements of anxiety to determinetheir equivalence in assessing anxiety before surgery. Forty-fourpatients awaiting breast cancer surgery completed the statescale of the state—trait anxiety inventory (STAI), thehospital anxiety and depression scale (HAD) and a 100-mm visualanalogue scale (VAS). Analysis restricted to correlations betweenthe scales gave the misleading impression that VAS scores wereinconsistent with those of the HAD and STAI. However, when scoreswere considered in relation to normative cut-off values to categorizeanxiety levels, the three scales showed good agreement. We concludethat the scales were equivalent in their assessment of anxietybefore surgery, but that reference to normative data was importantin establishing such equivalence and in determining the patient'sstate. ^*Present address: Rotman Research Institute, 3560 Bathurst Street,North York, Ontario M6A 2E1, Canada     

The Association of Different Measures of Insulinaemia with Vascular Risk Factors in Healthy Normoglycaemic Normotensive Non-obese Men and Women

Hyperinsulinaemia is said to be a risk factor for cardiovasculardisease, but the extent to which different insulinaemic measuresare associated with vascular risk factors in ostensibly healthyindividuals, and whether they operate independently in men andwomen, remains uncertain. The association between risk factors and various insulinaemicmeasures was examined in 148 men and 118 women who were normoglycaemic,normotensive, and non-obese (body mass index in men <27,in women <25). A 75 g glucose tolerance test was administeredafter blood sampling for fibrinogen, lipids, lipoproteins andinsulin. Insulin was also measured after 1 and 2 hours. Significantunivariate correlations (p<0.01) were most consistently recordedbetween insulinaemic measures and fasting serum triglyceridesin men and women, whilst systolic blood pressure only correlatedwith insulinaemia in women, and diastolic blood pressure correlatedwith fasting and 2 hour insulinaemic measures in men and women.Inconsistent associations were noted with total serum cholesterolin men and women, with high density lipoprotein cholesterol,body mass index, apoprotein B and A1 in men, and with fibrinogenin women. Age was not correlated with any insulinaemic measurein men or women. Differences in vascular risk factors between quintiles of theinsulinaemic measures were examined, after correction for bodymass index. The dominant association with fasting and post-glucoseload insulinaemic measures was with triglycerides, especiallyin women, with less frequent graded differences between quintilesobserved for total cholesterol, and diastolic and systolic bloodpressures in men and women. The incidence of other risk factors often only differed in thelowest or highest quintile in comparison to other quintiles,suggesting a threshold rather than a graded effect. Furthermore,differences in HDL cholesterol and apoprotein B were only recordedfor top quintiles of post-glucose challenge/integrated insulinaemicmeasures in men, whilst serum fibrinogen concentrations onlydiffered significantly in women in the top insulinaemic areaunder the curve quintile. In the absence of additional risk factors such as diabetes,hypertension and obesity, insulinaemic measures are not consistentlyrelated to blood pressure and measures of lipid metabolism andcoagulation, and are thus a weak predictor of other cardiovascularrisk factors. The vascular risk profile associated with insulinappears somewhat different in apparently healthy men and women.     

The Surgical Treatment of Cervical Œsophageal and Laryngopharyngeal Dysphagia

An account is given of the atiology and treatment of common conditions which cause dysphagia in the laryngopharynx and the cervical ?sophagus. Management of cancer is discussed in some detail. Discussion of foreign body and benign strictures due to corrosives and acid regurgitation has been excluded.     

Bartter's syndrome and diabetes mellitus

Abstract. We here report a case of Bartter's syndrome occurring in association with diabetes mellitus. The patient, an insulin-dependent diabetic, presented with hypokalaemia, inappropriate kaliuresis and metabolic alkalosis. He had high plasma renin activity, relatively low plasma aldosterone, and resistance to infused angiotensin II. A high potassium diet raised total body potassium and serum potassium, did not affect plasma renin activity, but raised plasma aldosterone significantly and did not alter the resistance to angiotensin II. Indomethacin administered acutely reduced urinary potassium and kallikrein excretion and, on chronic administration, lowered plasma renin activity, urinary chloride excretion, and raised serum potassium. Salt restriction resulted in a prompt and significant reduction in urinary sodium and chloride excretion. Urinary kallikrein excretion was very high throughout, increased with sodium restriction, and decreased with sodium loading. Oral potassium supplementation partially corrected the hypokalaemia, but did not affect blood sugar control. In this patient the primary defect appears to have been primary urinary potassium wasting, rather than sodium or chloride wasting. The striking effects of indomethacin suggest that prostaglandins may play a fundamental role in the genesis of the syndrome.     

SPINAL ANALGESIA FOR TRANSURETHRAL PROSTATECTOMY: Comparison of Plain Bupivacaine and Hyperbaric Lignocaine

Plain 0.5% bupivacaine and hyperbaric 5% lignocaine were comparedfor spinal analgesia in 100 patients undergoing transurethralprostatectomy (TURP). The time of onset, height of blockade,degree of hypotension, and blood loss were similar in both groups.The duration of blockade was considerably greater in the bupivacainegroup, resulting in a significant reduction in the requirementfor postoperative analgesia.     

Cancer curriculum in the Asia–Pacific: Opportunities and challenges in the age of globalization

With the rising incidence and prevalence of cancer in Asia–Pacific, the need for adequate cancer education of medical graduates in the region has become particularly urgent. There are 769 medical schools across the Asia–Pacific region in 33 countries serving over 60% of the world population in very diverse socioeconomic environments. This paper discusses some of the challenges for medical education in the Asia–Pacific in light of increasing globalization of health care, including the need to develop global standards in the area of diverse resources and health care priorities. It also points out emerging opportunities including online learning, telemedicine and collaborative educational initiatives across the region.