Promoting screening and early detection of cancer in men.

Gender is a factor in the risk assessment for many diseases. It may also impact on the way in which men assess their personal health or illness status and take action to prevent illness or promote well-being. This paper is focused on three objectives: (i) to foster an understanding of gender differences in health promoting behaviors; (ii) to review three health issues affecting males for which dissemination of health education, increased personal awareness and early detection may be beneficial in the reduction of morbidity and mortality; and (iii) to offer suggestions for nurses and other health care professionals to promote positive patient-provider interactions within a health-care framework for action.

Nurses' unique roles in randomized clinical trials.

Nurses are in an ideal position to promote patients' awareness of the role played by clinical trials in the advancement of health science and the subsequent improvement of patient care. The history of clinical trials and the four phases of clinical trials are described. Nurses' professional roles in clinical trial participation, such as helping the patient to identify open clinical trials and acting as clinical interpreter and patient advocate during the patient's participation in a trial, are detailed. Professional considerations that must be addressed by the nurse are reviewed and include ensuring that the trial has received approval from an Institutional Review Board for the participation of human subjects; that the responsibilities of participation are congruent with the nurse's personal values and workplace obligations; and that once engaged, the nurse can make the commitment to sustain participation in the trial. Most important, the nurse must keep the patient's needs and values uppermost in mind during the evaluation of potential clinical trials. Nurses have a critical role to play in the promotion of clinical trials, the recruitment of patients for clinical trial participation, the education of the patient and family, and the clinical care and support of patients throughout their participation in clinical trials.

Perceptual and enactment measurement of self-care.

The concept of self-care was conceptualized as having three major components: enabling perceptual elements (motivation, values, responsibility, and decision making); domains for enactment (cognitive/ perceptual, psychosocial/affective, and physical functioning); and self-care enactment factors (capacity), which included self-care action and knowledge adequate for self-care. A new tool, The Self-Care Agency Inventory, was designed to discriminate between those who will enact self-care and those who will not because of either a lack of knowledge or a lack of motivation. Content validity was demonstrated (.77 or greater from each scale) and concurrent validity documented. Alpha reliability for the new scale and principal components factor analysis of the scale items did not achieve desired levels, although a pilot sample demonstrated test-retest reliability of .82. The conceptual model is presented.

Experimental photodynamic therapy with a copper metal vapor laser in colorectal cancer.

In an attempt to define the best conditions for an adjunctive treatment of residual colonic microtumors by photodynamic therapy (PDT), an experimental model has been defined. S.c. HT29 colonic-cancer-cell tumors grown in nude mice were used and, 48 hr after i.p. administration of 30 mg/kg Photofrin (PH), laser illumination was performed with 75 or 150 Joules/cm2. The efficiencies of 2 lasers, the classically used rhodamine laser (RL) and a copper metal vapor laser (CMVL), were compared. The effects of PDT were assessed by histological and immunocytochemical (detection of a digestive enzyme, dipeptidyl-peptidase IV, as a marker of cell viability) follow-up and by the growth curve of the tumors after illumination. We conclude that, although the depth of necrosis resulting from PDT was nearly 3 mm at 75 J/cm2 and nearly 4-5 mm at 150 J/cm2 with both lasers, complete necrosis was obtained only with the CMVL at 150 J/cm2 (in 50% of the tumors). Under the other conditions, a layer of unaffected cells persisted at the pole opposite to laser illumination, resulting in growth curves lower than but parallel to those of the controls. Analysis of drug concentrations in the tumors and various organs, 48 hr after injection, i.e., at the time of laser illumination, revealed the presence of 21 micrograms/g dry weight PH in the tumors. The tumor vs. host-organ ratios were equal to or higher than 1 for the small bowel, colon, stomach, lung, skin and muscle. In contrast, the ratios were below 1 for the spleen, pancreas, kidney and liver.

Nursing education and service collaborate on graduate curriculum development.

Nursing and nursing education exist because of a need by society. Nursing education is translated into reality by those in nursing service. The authors present a systematic process that was used to determine the need in one community for a master's clinical specialization in pediatric critical care and analyze the relationship between nursing educational goals and the needs of nursing service. This method can be adapted and used by others in program development and evaluation.

[Incidental disclosure of an adrenal tumor. Diagnostic and therapeutic procedure]. / Découverte fortuite d'une tumeur surrénalienne. Stratégie diagnostique et thérapeutique.

Among upper abdominal computed tomography (CT) scans, 0.6 per 1000 fortuitously reveal an adrenal tumour, an "image pathology" now known as "adrenal incidentaloma". Should the clinician avoid useless, iatrogenic surgery or run the risk of failing to identify a malignant adrenocortical tumour? We outline a clinical procedure aimed at distinguishing between solid vs liquid, secreting vs non-secreting and primary vs metastatic tumour. Nevertheless, in the end the diagnosis may be uncertain, in which case tumour size becomes the deciding factor. For tumours of less than 3 cm close surveillance is advocated, whereas surgery is necessary for tumours larger than 3 cm; for tumours in between these sizes only the individual clinician can decide.

[Primary hyperparathyroidism. Apropos of 102 recent exploratory cervicotomies: diagnostic and clinical pitfalls]. / Hyperparathyroïdisme primaire. A propos de 102 cervicotomies exploratrices récentes: pièges diagnostiques et cliniques.

The authors report on various diagnostic pitfalls on 102 patients having undergone exploratory cervicotomy for primary hyperparathyroidism. A false positive diagnostic error was made on 2% of the cases, bringing to 100 the number of patients with a confirmed diagnosis of primary hyperparathyroidism. False negative diagnosis was made on 4% of the patients: two late diagnoses leading to an acute toxic state and death postoperatively in both cases; two pure psychiatric variants leading to repetitive hospitalizations in psychiatry. Error in diagnosis because of a masking effect was made in 4% of the cases:--one association with a clear cell nephro--epithelioma--one association with a multiple myeloma--two associations with a benign monoclonal gammapathy. The absence of hypercalcemia, a diagnostic pitfall in the modern form of this disease was found in 7% of the cases. PTH hypersecretion which is virtually a constant finding in the normocalcemic form of the disease obviates in most cases the need of a bone biopsy and quantitative histomorphometric analysis. The association with another endocrinopathy was found in 12% of the cases (2 MEN I, 1 MEN II, 9 hyperthyroidism). Because of its high frequency in the aged (22% greater than 75 years) the diagnosis of this disease is difficult for its signs are mimicked as well by the aging process. The preoperative topographic diagnostic error is avoided since there doesn't seem to be any test which would preclude the normal surgical procedure of carefully exploring all 4 topographic sites of the parathyroid. Surgical errors can be numerous but minimized with the increasing experience of the operator. Histological errors are seen mainly in the normocalcemic variety where only electron microscopy can detect the typical signs of cellular hyperactivity.

[Anesthesia for surgery of insulinoma]. / Anesthésie pour insulinome.

The difficulties of interpretation of blood sugar level changes during the postoperative period in the anaesthetic management of insulinoma are discussed. Several specific means reduced the errors in the assessment of the hyperglycemic rebound which occurred after the removal of the tumour. They consisted of continuous sugar infusion accorded to measured glucose levels, in order to maintain a constant blood sugar value between 50 and 70 mg X 100 ml-1 before removal of the insulinoma. Furthermore, analgesia was provided by high doses fentanyl. Sugar containing solutes were avoided during the procedure. Glucose levels rose slowly after tumour removal and reached 170 mg X 100 ml-1 at 120 min. This rebound was known to be of no help in ascertaining complete resection. Simultaneous determinations of blood glucose and insulin were obtained. The value of portal blood insulin was found to be normal (12.3 mU X l-1) 30 min after insulinoma removal. Turner's index calculated every 30 min decreased simultaneously (143) and reached a normal value at 120 min (39). These results, obtained during the surgical procedure all the more easily because of rapid laboratory procedures, could be better arguments in determining whether tumour removal has been complete.