Effects of acute exercise on state anxiety in breast cancer survivors

PURPOSE/OBJECTIVES

To examine the effects of an acute bout of exercise on state anxiety in breast cancer survivors.

DESIGN

A two-group (high and low state anxiety) by two-time (pre- and postexercise) mixed factorial design.

SETTING

Exercise physiology lab at the University of Alberta.

SAMPLE

34 stage I or II breast cancer survivors ranging in age from 39-65 (X = 50.50; SD = 6.62).

METHODS

Participants completed the State Anxiety Inventory prior to and five minutes following an acute bout of exercise.

MAIN RESEARCH VARIABLES

State anxiety.

FINDINGS

A main effect resulted for group (p < 0.01) and time showing that state anxiety significantly decreased from pre- to postexercise (p < 0.03). Group by time interaction showed that state anxiety for the low state anxiety group did not change from pre- to postexercise (p > 0.05); however, state anxiety significantly decreased in the high state anxiety group (p < 0.03).

CONCLUSION

Acute exercise may be an effective intervention in reducing state anxiety in breast cancer survivors, especially those with high state anxiety.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses should be aware that in addition to other traditional anxiolytic therapies (e.g., relaxation therapy) commonly prescribed, acute exercise is an effective method for reducing state anxiety in breast cancer survivors.

The significance of Erb-b2 immunostaining in cervical cancer

OBJECTIVE

The aim of this study was to assess the relationship between survival and erb-b2 immunohistochemical staining in patients with early stage cervical carcinoma.

METHODS

Archival specimens for 126 patients with stage IB/IIA cervical carcinoma treated with radical hysterectomy and bilateral pelvic node dissection (RH-BPND) were retrieved and submitted to immunohistochemistry for ERBB2 expression. The association between positive results and poor survival was assessed in a multivariate analysis.

RESULTS

Erb-b2 immunostaining was significantly associated with poor survival (P = 0.0284) but less so than parametrial extension (P = 0.0014) and nodal disease (P = 0.0106). Tumor type (squamous/adenosquamous/adenocarcinoma) and the status of surgical margins were not significantly associated with survival.

CONCLUSIONS

These results supported further investigations of ERBB2 expression as a marker of high-risk disease in patients treated with RH-BPND.

The laryngeal mask airway: a new technique for fiberoptic guided vocal cord biopsy

STUDY OBJECTIVE

To describe a new technique for vocal cord biopsy involving placement of a laryngeal mask airway (LMA) during general anesthesia and fiberoptic guided biopsy. To report our early experience with this technique.

DESIGN

Descriptive study.

SETTING

Teaching hospital.

PATIENTS

10 patients undergoing vocal cord biopsy for minor laryngeal pathology and with no evidence of infraglottic airway obstruction.

INTERVENTIONS

Patients were premedicated 1 hour preoperatively with pethidine 1 mg/kg and atropine 0.01 mg/kg. Following preoxygenation, anesthesia was induced with propofol 2.5 mg/kg and fentanyl 1 mg/kg. Once airway control was established with a facemask, vecuronium 0.1 mg was given and anesthesia established with oxygen (O2) and nitrous oxide mixture and isoflurane 1% to 2%. Gentle direct laryngoscopy was then performed to inspect the pharyngeal structures and the LMA was then inserted in the standard manner by highly experienced LMA users. A fiberoptic scope was passed via a self-sealing mount down the shaft of the LMA to the level of the vocal cords. The vocal cords were then sprayed with local anesthetic and the biopsy taken.

MEASUREMENTS AND MAIN RESULTS

The age and weight range were 29 to 57 years and 65 to 85 kg, respectively. All patients were smokers or recent ex-smokers. LMA insertion was readily achieved in all patients, and an excellent view of the vocal cords was obtained. There were no problems with ventilation or obtaining tissue samples, and O2 saturation remained greater than 95% throughout the perioperative period. Tissue samples were adequate in all patients. Hypertension and other adverse cardiac events did not occur during the procedure, which lasted 10 to 20 minutes. There were no problems during emergence from anesthesia, and all patients were discharged home on the same day.

CONCLUSIONS

The technique has potential advantages over suspension microlaryngoscopy in that it is relatively noninvasive, it allows good airway control with adequate views of the vocal cords, and it facilitates a smooth recovery.

Anaesthesia for laser pharyngoplasty--a comparison of the tracheal tube with the reinforced laryngeal mask airway

A common cause of snoring is palatal flutter which occurs when turbulent air flow causes the flexible soft palate to flutter. Surgical correction involves either removal of the soft palate or a reduction in its flexibility. Laser pharyngoplasty is a new surgical procedure designed to stiffen the soft palate. It presents a unique combination of problems for the anaesthetist. In this paper we describe the evolution of the anaesthetic technique for laser pharyngoplasty and analyse the results of the first 165 cases. Points of particular interest include the use of the reinforced laryngeal mask airway compared with the tracheal tube and late onset pain.

A histological grading system for the evaluation of co-existing NID with Hirschsprung's disease

The significance of dysplastic features in the surgical pullthrough segment of bowel in patients with Hirschsprung's disease (HD) has not yet been clarified. The aim of this study was to evaluate prospectively the ganglionated proximal bowel in 26 patients with HD (January 1988 through January 1991). The significance of dysplastic features and their influence on post operative outcome were evaluated by means of a newly devised histological scoring system based on the morphological features. Functional outcome was assessed clinically at follow-up interview. Comparison was with control specimens from 22 patients undergoing unrelated bowel surgery and a further 5 patients with neuronal intestinal dysplasia (NID). Results indicated a wide spectrum of histologically identified dysplastic features in patients with NID, the ganglionated bowel of HD and controls. Although individual abnormal features were noted in the control group, significant degrees of dysplasia were absent. The overall degree of dysplasia was less striking than that observed in NID and in the 5 patients in whom NID co-existed with HD. Dysplasia of the ENS in residual bowel could be correlated with postoperative dysfunction in 4 out of 5 patients (80%) with HD and features of co-existing NID. In addition, milder symptoms were noted in 50% of patients having a borderline score (5-6/12). This study emphasizes the relationship between clinical obstructive symptoms and a high degree of dysplasia within the ENS. A histological grading system is of value in evaluating the spectrum of abnormal findings and prospectively identifying those with functional significance in patients with NID co-existing with HD.

Psychological reactance: effects of age and gender

A self-report, attitudinal questionnaire was administered to 1,717 adult Australians between 18 and 40 years old to examine the effects of age and gender on psychological reactance. Analysis yielded a significant age effect: As age increased, the level of reactance tended to decrease. No significant differences in reactance emerged in relation to gender. A significant interaction between age and gender was found.

Secondary effects of prolonged intestinal obstruction on the enteric nervous system in the rat

Motility disturbances following prolonged intestinal obstruction have been attributed to secondary effects. This study aimed to demonstrate the effects of incomplete obstruction on the enteric nervous system (ENS) of a rat model. Surgical placement of a nonstrangulating ligature encircling the distal bowel was performed in 41 freshly weaned rats. Anesthetic protocol included Ketamine, ether, or Xylazine (an alpha 2-adrenergic agonist). Histological evaluation was by ganglion cell morphology, histochemical staining for acetylcholinesterase (AChE) and tyrosine hydroxylase (TOH) immunocytochemistry. Forty-one freshly weaned LE rats were divided into controls (8), sham procedures (8), intestinal obstruction (16), and a group of rats with colonic biopsy performed prior to and following experimental obstruction (9). The rats were sacrificed at periods varying between 14 and 45 days post experimental obstruction (median survival, 27 days). Histological changes included elongation of ganglion cells and a decrease in the number per 5-mm slide in obstructed animals. No other obstruction specific differences were detected. A significant (P < .01) increase in AChE in the submucous plexus was recorded in Xylazine-anesthetized animals. No obstruction-specific effects could be demonstrated in the ENS, suggesting that prolonged obstruction without ischemia does not result in any significant alterations in the ENS. Pharmacological stimulation of the alpha 2-adrenergic receptor appeared to result in an increase in AChE. This mechanism may help to explain a possible role for the adrenergic system in the increased AChE levels in affected bowel in patients with Hirschsprung's disease.

Medium term fate of cartilage grafts from children after laryngo-tracheoplasty

Cartilage grafts or biopsies of such grafts were obtained from six children who had undergone laryngo-tracheoplasty surgery at times ranging from 10 to 38 months after surgery. The histological appearance of the grafted cartilage was of gradual degeneration with chondrocyte necrosis and replacement of cartilage matrix by fibrous tissue.

Further experience with regional radiofrequency hyperthermia and cytotoxic chemotherapy for unresectable hepatic neoplasia

The authors report on 178 patients with unresectable hepatic tumors who have been treated with 1 to 25 (median, 6) courses of radiofrequency hyperthermia (RFHT) and chemotherapy. In 137 patients, the hepatic tumors consisted of metastases from colorectal adenocarcinomas. For patients who had no previous therapy and who had colorectal metastases with no extraheptic disease, cumulative survival at 52 weeks' follow-up was 80.5% and partial tumor regression was seen in 78.4%. Among the 69 patients who previously had conventional treatment for their hepatic disease, partial regression was seen in 43.5%. We are no longer monitoring tumor core temperature routinely, as the invasive methods currently in use yield irreproducible results; the risks to the patient cannot be justified in view of the questionable relevance of the data obtained. A prospective randomized study of systemic chemotherapy with or without RFHT in patients with colorectal hepatic metastases is in progress.

Hyperthermia for cancer: a practical perspective

A causal relationship between hyperpyrexia and tumor regression was first suggested in 1866, when Busch reported the cure of a histologically diagnosed sarcoma in a middle-aged woman, following a bout of erysipelas. Over the years, interest in the effect of heat on cancer has remained alive, but this interest has increased dramatically in recent years. The literature on this subject is broadly reviewed and the clinical results discussed. It is apparent from clinical studies thus far that it is a relatively simple undertaking to treat superficial neoplasms with hyperthermia. However, the major challenges in clinical thermotherapy pertain to patients with deeply situated tumors. The lack of safe and reliable methods of monitoring temperature in deep tissues is a major impediment to a thorough understanding of thermal dosimetry in clinical hyperthermia, and routine thermal dosimetry in clinical hyperthermia will have to await the development of reliable noninvasive thermometry. As responses have been reported with modest levels of hyperthermia, the need for thermometry is somewhat lessened, given that invasive monitoring is imperfect and somewhat risky when used in deeply seated tumours. The eventual place of thermotherapy in the treatment of malignant tumours in man is as yet unclear and must be rigourously and thoroughly assessed in well-designed, prospective, randomized patient trials.

High temperature solution calorimetry. Part 1. Development of a spherical solution calorimeter

A high temperature solution calorimeter of a novel design has been developed whereby the separated components are brought together and mixed within a completely enclosed, vacuum-sealed cell. The instrument consists of an inner spherical compartment containing the reaction cell, surrounded by a number of concentric spherical shells made of Inconel alloy. The calorimeter may be operated at temperatures up to 1 200 °C. The temperature-sensing circuit includes a differential thermopile, a d-c. microvolt amplifier, and a recording millivoltmeter. With this instrument calorific effects of the order of 0.1 cal could be detected.