Psychological reactions to radiation therapy: Reconsideration of the adaptive aspects of anxiety

A common form of cancer treatment is radiation therapy. In this investigation individual differences in the psychological reactions of 45 patients undergoing external treatment were examined in the context of the Janis (1958) and linear decline models (e.g., Spielberger, Auerbach, Wadworth, Dunn, & Taulbee, 1973) of medical stressor anxiety. Evaluation included pre- and postradiation assessments of the subjects' state and trait anxiety, somatic complaints, and treatment side effects. Technologists administering the daily treatments assessed behavioral indicants of affective distress. Data analyses revealed that increases in complaints and side effects were reported by all patients at treatment conclusion. More interesting, significant changes in state anxiety were obtained from pre- to posttreatment: (a) Patients with an initial high level of anxiety reported a significant reduction, although they remained the most anxious subgroup; (b) patients with a moderate level of pretreatment anxiety reported no change; and (c) patients with low levels of anxiety reported significant increases in state anxiety. No change in trait anxiety was found for any group, suggesting that the foregoing changes in state anxiety were not simply attributable to regression. Data trends suggested that patients who were either low or high in state anxiety were also characterized by more anger or hostility than patients moderate in anxiety. The findings are consistent with the Janis model, which posits that in threatening situations the level of fear can potentially determine the adequacy of adaptation.

Oblique chest film: value in routine and selective use

A retrospective analysis is presented of 308 consecutive cases in which four views of the chest (right and left anterior oblique, posteroanterior, and lateral) were obtained. Most cases (257) were from adult cardiac clinics or thoracic surgery clinics, where the indications were for questionable cardiac abnormality, known cardiac abnormality, or thoracic malignancy. Fewer cases (37) were studied to attempt clarification of possible abnormality on routine films. Of the 257 routine studies, the oblique views yielded no further information in 97.6% of cases, and missed lesions in 1.3%. In the selective group, the oblique views provided information or confirmatory evidence in about 95% of cases when requested by radiologists. The results throw considerable doubt on the value of oblique films in routine studies, but suggest that they may still have a value in delineating possible abnormalities seen on other views or in cases of pleural disease.

Anxiety and cancer treatment: response to stressful radiotherapy

Previous research with individuals undergoing surgery or diagnostic procedures provided a conceptual framework for analysis of radiation therapy, a common form of cancer treatment. The present investigation was designed to document the magnitude of anxiety patients experience in response to one particularly stressful form of radiation treatment. In addition, the change in anxiety responses with repeated exposures and individual differences among patients that may affect their adjustment were explored. In Part 1, gynecologic cancer patients receiving their first internal radiotherapy application were studied. As the time for treatment neared, subjective and physiologic indicants of anxiety and distress among the patients significantly increased. By 24 hours post-treatment, anxiety for all patients remained elevated. These post-treatment data are convergent with other investigations of post-treatment distress among cancer patients, but contrast with data obtained from those receiving treatment for benign conditions. A subset of the women who required two applications of radiotherapy participated in Part 2. These patients continued to respond negatively during the second treatment. Data on individual differences in anxiety responses (i.e., low vs. high anxiety) were obtained in both investigations and suggest that those with low levels of pre-treatment anxiety experience considerable disruption post-treatment.

Pancreatic and peripancreatic vessels: embolization for control of bleeding in pancreatitis

Bleeding associated with pancreatitis has a high mortality rate. Angiographic demonstration of uncontrollable bleeding or large pseudoaneurysms is an indication for emergency surgery. We have encountered a group of patients with obvious clinical gastrointestinal hemorrhage out of proportion to angiographic findings. Vessel abnormalities included areas of encasement, small pseudoaneurysms, and occasional extravasation without a clearly defined source. With the high risk of mortality in such patients, embolization is a viable method of therapy. Three patients are described who had different angiographic presentations and in whom hemorrhage was safely controlled with embolic therapy using nonpermanent occlusive materials.

Psychosexual adjustment after vulvar surgery

Fifteen patients treated surgically for vulvar cancer from two institutions participated in semistructured interviews and objective assessment to examine postoperative psychologic, social, marital, and sexual adjustment. Descriptive statistics indicate that after vulvar surgery patients report mild distress, but they report reasonable levels of and satisfaction with their free-time and social activities. Mild levels of marital distress may exist. Sexual functioning and body image appear to undergo major disruption despite the fact that intercourse remains possible. Women reported levels of sexual arousal at the eighth percentile and body image at the fourth percentile. Although replication of these findings is clearly necessary, this investigation provides the first substantive look at the posttreatment life circumstances for these patients and offers a data base for future investigation.

Psychosexual adjustment following pelvic exenteration

Fifteen pelvic exenteration patients from 2 institutions participated in semistructured interviews and objective assessment to examine postoperative psychologic, social, and sexual functioning. Analyses of variance indicated significant differences between the sexually active and nonactive patients and the patients with a neovagina and those with no vaginal capacity only in the area of sexual functioning, not in psychologic or social adjustment. Descriptive statistics for the entire group of patients provide a view of psychosocial adjustment for the average pelvic exenteration patient. Long after such patients are asymptomatic and clinically free of disease, they appear mildly distressed and depressed. However, these women report active and satisfactory levels of social and free-time activities. Sexual functioning continues as the area of greatest disruption for these patients and, as a group, they resemble severely sexually dysfunctional healthy women. This investigation provides a substantive look at the post-treatment life circumstances of these patients and offers a data base for future investigations.

Treatment for Gynecologic Cancer: A Review of the Effects on Female Sexuality

Approximately 75,000 new cases of gynecologic cancer are diagnosed in the United States each year. Since few women can be treated by chemotherapy alone, most undergo extensive treatments that directly alter their sexuality either by causing specific anatomic changes or by generating concerns about continued responsiveness or activity. The major treatments for gynecologic malignancies including radiation therapy or radical hysterectomy for cervical carcinoma, radical vulvectomy for vulvar carcinoma, and pelvic exenteration for recurrent disease, are outlined. Research relating to their effects on female sexuality is critically reviewed. Also discussed are the relevant domains of treatment and patient characteristics that need assessment and investigation in this new and important research area.

Primary orgasmic dysfunction: diagnostic considerations and review of treatment

As a diagnostic category, primary orgasmic dysfunction includes all women who have never experienced orgasm under any circumstances except sleep or fantasy. However, the research samples of nonorgasmic women in clinical reports and empirical investigations are heterogeneous with regard to disruption of earlier phases of the sexual response cycle and emotional concomitants of the dysfunction. The major treatment models—systematic desensitization, sensate focus, directed masturbation, and hypnosis—are presented, and empirical support is reviewed. Separate discussion is included for investigations comparing treatment modalities. Finally, a strategy for future programmatic sex therapy research is suggested within the broader context of psychotherapy outcome research.

E receptor expression of T lymphocytes in T lymphoproliferative diseases

The lymphoid component of skin infiltrates from 6 cases of mycosis fungoides and 2 cases of T cell chronic lymphatic leukaemia consisted almost exclusively of T lymphocytes with abnormally high E receptor expression. Such T cells were also found to dominate the skin infiltrates from 10 patients with severe atopic dermatitis. Blood T lymphocyte counts from all types of patients were within the normal range, but even the blood T lymphocytes of the patients had a strong E receptor expression. The bone marrow in atopic dermatitis and in mycosis fungoides showed normal T cell counts with normal E receptor expression. Supported by basic lymphocyte-kinetic considerations it is likely that the skin in T lymphoproliferative diseases is characterized by an abnormal ability to home and/or to trap T lymphocytes with strong E receptor expression.

A comparison of systematic desensitization and directed masturbation in the treatment of primary orgasmic dysfunction in females

Thirty subjects seeking treatment for primary inorgasmia accompanied by sexual anxiety or aversion were assigned to one of three groups: systematic desensitization (SD), directed masturbation (DM), or waiting list control (WL). Following treatment, subjects were retested, and the WL group then received directed masturbation treatment. A third testing constituted a follow-up for the SD and DM groups and a posttreatment testing for the WL. Both treatments were equally effective in improving subjects’ sexual self-acceptance and increasing sexual pleasure. Changes in anxiety were negligible; however, sexual arousal and orgasm for DM and WL subjects increased. The gains of the WL group not only replicated the findings of the DM group but also were of greater magnitude.

Acrokerato-elastoidosis: a case report

Acrokerato-elastoidosis belongs to the group of diffuse palmo-plantar keratoses without associated symptoms. We report a 25-year-old man who has had typical skin lesions for 5 years. The histopathological changes are described. By electron microscopy, changes in dermal elastic fibres as previously reported in patients with acrokerato-elastoidosis were absent.

Greeting Cards as Data on Social Processes

The choices that individuals make when purchasing greeting cards influence what designs and sentiments are subsequently available. This suggests that the nature of the available greeting cards can be used as an archival data source to gauge social attitudes and interpersonal communicative processes. A study is presented to illustrate a method in which greeting cards are used to examine how parents communicate with their children on special occasions. The advantages and disadvantages of the approach are discussed.

Pyoderma gangrenosum associated with transient acantholytic dermatosis (pemphigus erythematosus-like) and paraproteinemia

A 69-year-old man with recurrent eruptions of pyoderma gangrenosum for 4 years is described. The patient also suffered from paraproteinemia (increased IgA with M-component) and transient acantholytic dermatosis resembling pemphigus erythematosus. He had no intestinal symptoms.