An evaluation of a therapeutic radiographer led "sexual care after radiotherapy" clinic.

INTRODUCTION: Changes to sexuality and intimacy are a common consequence of a cancer diagnosis and treatment. Difficulties with sexual functioning and body image have been reported in over 50% of those treated for pelvic malignancies or breast cancer. The provision of sexual care support after radiotherapy is not adequately addressed by oncology professionals yet patients who have the opportunity to discuss sexual issues experience reduced sexual morbidity. This paper describes the evaluation and patient satisfaction of a novel and innovative clinic led by therapeutic radiographers for the management of sexual dysfunction. METHOD: Quantitative data was collected from NHS Friends and Family Test (FFT) patient questionnaires to assess how patients rated the service on a scale from not likely to extremely likely to recommend the service. A qualitative, thematic analysis of the comments provided insight into patient satisfaction and experience. RESULTS: Overall, 33 patients attended the clinic from 2019 to 2020. An 82% return rate of FFT questionnaire's showed 94% of patients were extremely likely and 6% were likely to recommend the service. Three emergent themes were the quality of information provision, the conduct of the staff member and the consultation experience. Patients stated that they were given a range of solutions and many cited a better understanding of their sexual issues. CONCLUSION: Sexual function is an important component of quality of life and sexual dysfunction can cause on-going distress, interfering with recovery. This clinic offers an opportunity to discuss issues and provides an important mechanism of support for patients to live with and beyond their cancer diagnosis. IMPLICATIONS FOR PRACTICE: Oncology professionals should receive training and education to raise sexual issues with their patients and ensure relevant services are provided.

Comparative evaluation of clinical efficiency of intramuscular diazepam-ketamine, medetomidine-ketamine, and xylazine-ketamine anaesthesia in Ring-necked pheasants (Phasianus colchicus).

BACKGROUND: Several injectable anaesthetics and sedatives are used in various avian species for general anaesthesia. Birds are very sensitive animals and any mismanagement in a crisis can lead to immediate shock and death. Therefore, careful selection of the safest possible anaesthetic agent and dose is very important. AIMS: The aim of this study was to examine the clinical efficiency of diazepam-ketamine (DK), medetomidine-ketamine (MK), and xylazine-ketamine (XK) combinations anaesthetic regimens in pheasants. METHODS: Twenty-four pheasants were divided into three equal groups and received one of three anaesthetic combinations by intramuscular injections: 9.0 mg/kg diazepam and 150.0 mg/kg ketamine, 0.20 mg/kg medetomidine and 80.0 mg/kg ketamine, and 3.0 mg/kg xylazine and 80.0 mg/kg ketamine. Each pheasant was pre-medicated with sedative drugs and 5 min later, anaesthesia was induced with ketamine injection. RESULTS: The weak time (2.50 ± 1.07 min; mean±SD) and down time (6.13 ± 1.25 min) were shortest in group XK. The sleep time was longest (73 ± 20.24 min) while the recovery time (157 ± 13.61 min) was shortest in group MK. Muscle relaxation was excellent during the anaesthesia in all groups. The recovery phase of the birds was uneventful. Heart rate (HR) in DK group was statistically higher than MK and XK groups. Body temperature (BT) decreased in all groups compared to baseline values and those of MK group were lower than DK and XK groups. Respiratory rate (RR) in XK group was significantly lower than DK and MK groups. CONCLUSION: In conclusion, the MK combination shows better anaesthetic outcome compared to DK or XK combinations in pheasants.

Effects of electromagnetic field (1.8/0.9 GHz) exposure on growth plate in growing rats.

The purpose of this study was to determine the effects of whole-body electromagnetic field (EMF) exposure on growth plates in growing male rats. Two groups of rats were exposed to either 900 MHz EMF or 1800 MHz EMF 2 h/day for 90 days. Sham control rats were kept under similar conditions without exposure to the EMF. The rats in the EMF group experienced a more rapid weight gain and increase in length (p < 0.05). Calcium, growth hormone, estradiol and testosterone levels in the EMF groups were higher (p < 0.05). The Safranin O staining density of femoral growth plate was lowest in the reserve zone of rats exposed to 1800 MHz and was increased in the proliferative zone of the control group (p < 0.05). The trabecular zone was thinnest among all zones and the reserve and proliferative zones were thicker (p < 0.05) than other zones in 1800 MHz group.In conclusion, 1800 MHz and 900 MHz EMF may cause prolong the growth phase in growing rats.

Surgical correction of a bilateral congenital tarsal hyperextension deformity in a cat.

CASE DESCRIPTION: An approximately three-month-old, 0.45 kg female Domestic Shorthaired kitten with stiff hyperextended hindlimbs distal to the talo-central joint is reported. Attempts at repositioning of the joints by flexion failed while increased manipulative forces caused signs of pain and vocalization. Orthogonal radiographic views revealed a significant malarticulation of the tarsus. Goniometric measurments revealed a 145° extensor and 95° internal torsional deformity. TREATMENT AND OUTCOME: Pantarsal arthrodesis with a transarticular external fixation system was performed for both limbs in two separate stages. Pre-assembled frames were composed of two 40 mm diameter half rings (on the medial side) and two 40 mm diameter full rings connected with two pre-contoured (125° flexion) rods from proximal to distal. Following transection of the superficial and deep digital flexor tendons, cartilage was removed from the articular surfaces, autologous cancellous bone graft was inserted, and joints were fixed in 125° flexion with pre-contured external frames. The cat commenced weight-bearing bilaterally immediately postoperatively. Frames were removed 32 and 27 days after application. Two months after frame removal, joint fusion was confirmed and full weight-bearing at the walk and run was achieved. CLINICAL RELEVANCE: To our knowledge, this is the first report of surgical correction of a bilateral congenital tarsal hyperextension deformity by pantarsal arthrodesis using a transarticular external fixation system.

Evaluation of bee venom and hyaluronic acid in the intra-articular treatment of osteoarthritis in an experimental rabbit model.

The aim of this study was to investigate bee venom and hyaluronic acid in the intra-articular treatment of osteoarthritis in an experimental rabbit model. Forty-five rabbits were used and they were randomly divided into three groups (BVI, BVII, and HA) and each group was divided to two subgroups to evaluate the radiologic, magnetic resonance imaging, histopathologic, and biochemical evaluation in post treatment second week (a) and twelfth week (b). Radiologically, a significant difference was observed in the HA group (P<0.05). The MRI evaluation of at any time in group BVI(b) was found to be different. No significant differences were seen between the groups, biochemically. Histopathologically, cellularity, and orthochromasia was evident with Safranin-O in the BVI(b) and BVII(a); adhesions were seen in the BVII(a) group and clustering of chondrocyte in the HA(b) group were found to be different. Consequently, intra-articular application of HA and BV for experimental model of osteoarthritis has no significant influence upon recovery after therapy.

Effects of exposure to electromagnetic field (1.8/0.9 GHz) on testicular function and structure in growing rats.

The aim of our study was to evaluate the possible effects of whole-body electromagnetic field (EMF) exposure on reproduction in growing male rats. Male albino Wistar rats (2 days old) were exposed to EMF 1800 and 900 MHz for 2 h continuously per day for 90 days. Sham control was kept under similar conditions except that the field was not applied for the same period. After blood samples were collected, the animals were sacrificed 24 h after the last exposure and the tissues of interest were harvested. The mean plasma total testosterone showed similarity among the two study groups and was significantly higher than the sham control rats. The percentage of epididymal sperm motility was significantly higher in the 1800 MHz group (P<0.05). The morphologically normal spermatozoa rates were higher and the tail abnormality and total percentage abnormalities were lower in the 900 MHz group (P<0.05). Histopathologic parameters in the 1800 MHz group were significantly higher (P<0.05). In conclusion, the present study indicated that exposure to electromagnetic wave caused an increase in testosterone level, epididymal sperm motility (forward), and normal sperm morphology of rats. As a consequences, 1800 and 900 MHz EMF could be considered to be a cause of precocious puberty in growing rats.

Treatment of unilateral congenital flexural and torsional limb deformities with circular external skeletal fixation system in two calves.

CASE DESCRIPTION: Two calves with unilateral congenital flexural and torsional limb deformities below the hock joint of the left hindlimb were presented to Veterinary Teaching Hospital of the Ondokuz Mayis University. According to clinical, goniometric and radiological examinations, flexural (130°-40°) and torsional (90°-180°) deformities were diagnosed. Except for the limb deformities, both animals were otherwise completely healthy. TREATMENT AND OUTCOME: In case 1, hock joint arthrodesis was performed using a circular external skeletal fixation system with four full rings 160 mm in diameter. In case 2, the deformity was corrected by fixation after transverse osteotomy at the level of the proximal metatarsals with four full rings 150 mm in diameter, and arthrodesis of the fetlock joint with three full rings 100 mm in diameter. According to clinical examinations and follow-up telephone interviews performed 15 and 24 weeks after discharge, functional use with slight lameness in case 1 and full functional use in case 2 had been achieved. CLINICAL RELEVANCE: None of the previously reported cases of flexural deformity had radiographic signs similar to those of the calves in our report, and the deformities were not as severe as those reported here. To our knowledge, this is the first report of treatment of unilateral congenital flexural and torsional deformities in calves with a circular external skeletal fixation system.

Management of femoral fractures in dogs with unilateral semicircular external skeletal fixators.

OBJECTIVE: To report use of semicircular external skeletal fixators (ESF) for management of femoral fractures in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=16) with femoral fractures (n=18). METHODS: A semicircular ESF system composed of 6-hole 45° or 5-hole 40° carbon-fiber arches, 6 mm threaded rods, half pin fixation bolts, 6 mm nuts, and negative profile end-threaded half pins were used for open repair of femoral fractures. ESF configuration, complications, limb use, fixator removal time, and functional outcomes were evaluated. Outcome was graded as excellent, good, fair, or poor. RESULTS: Seventeen fractures with sufficient follow-up healed. Eight dogs started using the limb immediately after waking up from anesthesia whereas initial limb use was 1-4 days after repair in the other dogs. Time to fixator removal ranged from 28 to 63 days (mean, 38 days). Functional outcome was excellent in 13 cases, good in 4, and poor in 1 nonunion. CONCLUSION: Semicircular ESF combined with open surgical reduction can be used to successfully repair metaphyseal and diaphyseal femoral fractures in young growing dogs.

Stabilisation with dorsal and ventral fixation of a traumatic cervical instability in a dog.

This case study reports the outcome of dorsal and ventral stabilisation of a traumatic cervical instability in a dog. A 2-year-old, male Pointer was admitted following a motor vehicle accident. Clinical examination revealed non-ambulatory tetraparesis, severe neck pain and upper motor neuron changes in all limbs. Deep pain response was present. Subluxation of C2/3 and fractures of the dorsal spinous process and lamina of C2 were observed on radiographs. Ventral stabilisation was performed with screws and bone cement (polymethylmethacrylate). For dorsal fixation of the fractures, screws and cerclage wire were used. The dog stood up independently after 1 month, was able to walk 1.5 months postoperatively and had recovered completely at 1 year following surgery. We conclude that combined stabilisation techniques are effective for this type of cervical fracture in which the dorsal, middle and ventral structures of the vertebra are severely disrupted.

Status epilepticus treated with a muscle relaxant: the first success.

In 1958, an 11-year-old girl with status epilepticus was given the current treatments which failed to control the convulsions. In order to stop the fits, protect the airway, prevent hypoxia and hyperpyrexia, intermittent positive pressure ventilation (IPPV) and complete muscle paralysis with d-tubocurarine was used for a total of 6 h. The girl made a complete recovery, the first patient to do so using this plan of action.

Coronary revascularisation in young adults.

OBJECTIVE: To evaluate the long-term outcome of coronary artery bypass surgery (CABG) in patients < 40 years old and to determine factors predictive of adverse outcomes. METHODS: Retrospective review of data on 220 patients who underwent isolated CABG at Green Lane Hospital, New Zealand from 1970 to 1992. RESULTS: The actuarial survival after surgery was 91, 74 and 50% at 5, 10 and 15 years, respectively. Recurrence of ischaemic symptoms occurred at a median time of 72 months, and only 20% of patients remained asymptomatic 10 years after CABG. Univariate analysis of potentially adverse surgical factors showed that patients who had prolonged bypass time (> or = 100 min, P < 0.007) had increased late mortality. There were two distinct operative eras with respect to the use of IMA conduits (4% pre 1985, 87% post 1984) The relationship between IMA conduits use and survival was significant on time independent analysis (P < 0.02), but was not using the log-rank test. Preoperative clinical characteristics associated with increased late mortality were impaired left ventricular function (end-systolic volume (ESV) > or = 80 ml, P = 0.008; ejection fraction < 40%, P = 0.0005), and lack of aspirin use either pre- or post-operatively (P < 0.0001). Multivariate analysis indicated that reduced ejection fraction (P = 0.04) and prolonged bypass time (P = 0.05) was associated with an increased risk of late death. Aspirin therapy (P = 0.001) was associated with decreased late mortality. Cumulative events rate of reintervention and mortality was reduced in female patients (P = 0.0009). At review, 45% of patients had total cholesterol > 6.5 mmol/l. CONCLUSION: To avoid the early recurrence of symptoms, the need for reintervention and late mortality, young patients should receive IMA conduits, cardioplegia as myocardial protection, aspirin and therapy to modify/ameliorate their risk factors including dyslipidaemia, diabetes and left ventricular dysfunction.

Improving schizophrenic in-patients' Wisconsin card-sorting performance.

The effectiveness of a training procedure to improve schizophrenic patients' Wisconsin Card Sorting Test performance was investigated. In the absence of the monetary incentive often employed, 10 schizophrenic in-patients' performance improved with training. This study provides further evidence that the cognitive deficiency associated with the frontal lobe, implied by schizophrenic patients' typically poor Wisconsin Card-Sorting Test performance, is remediable.

Late outcome after coronary artery bypass graft surgery in patients < 40 years old.

BACKGROUND: Randomized trials confirm the long-term efficacy of coronary artery bypass graft surgery (CABG), although there are no randomized data in patients < 40 years old. Because these patients have been reported to have an early recurrence of symptoms, the long-term postoperative outcome was examined. METHODS AND RESULTS: The long-term outcome of patients (n = 221) < 40 years old undergoing CABG at Green Lane Hospital, New Zealand, from 1970 to 1992 was determined. The 30-day mortality rate was 1.8% for initial and 9.5% for redo CABG. The median times to angina or myocardial infarction (recurrent ischemic event), further intervention, and death were 6.0, 9.6, and 14.2 years, respectively. Factors associated with increased late mortality on univariate analysis included end-systolic volume (ESV) > or = 80 mL (P = .004; 10-year mortality 19% versus 39% ESV > or = 80 mL), no internal mammary conduit (P = .01), no lipid-modifying therapy (P = .005), and no postoperative aspirin use (P = .0002); the latter was also associated with increased recurrent ischemic events (P = .04) or increased reintervention (P = .02). On stepwise logistic regression analysis, factors associated with increased late mortality were increasing ESV (P = .004), no internal mammary artery conduit (P = .009), diabetes (P = .04), and no postoperative aspirin (P = .02); the latter was also associated with increased recurrent ischemic events (P = .02). Hypercholesterolemia (> or = 6.5 mmol/L) was present in 65% of patients at presentation and 45% at follow-up. CONCLUSIONS: To attempt to prevent recurrent ischemia or late death, patients < 40 years old who require CABG should receive internal mammary conduits, aspirin, lipid-modifying therapy, therapy to inhibit ventricular dilatation, and strict diabetes management.

Needle tracheostomy: a laboratory study.

Percutaneous needle tracheostomy and transtracheal ventilation continues to be advocated for the management of upper airway obstruction. Recent studies recommend the use of artificial ventilation. However, as apparatus for this is not always available and because there remains some doubt regarding conditions for successful use of needle tracheostomy during spontaneous respiration, we undertook such a study in dogs. Pressure-flow characteristics of short hollow needles 18-10 SWG were first determined. The smallest of these (14 SWG Bardic Intracath) that would deliver flow sufficient (by calculation) to meet the respiratory requirement of 10-13 kg laboratory dogs was selected for further study. Respiration was possible by spontaneous or artificial methods in the presence of complete tracheal occlusion. Little or no deterioration was noted in an hour of such breathing. Artificial ventilation by machine and by hand could considerably lower PaCO2. We conclude that the technique is possible provided appropriate needles are selected and care is given to their method of use.

The effect of glucose-insulin-potassium on experimental myocardial infarction in the dog.

The effect of glucose-insulin-potassium (GIK) infusions was studied in 45 dogs after left anterior descending coronary artery ligation. GIK caused a modest increase in lactate concentration in small veins draining the infarct but did not affect glucose uptake. No effect on creatine kinase activity in the infarct was seen from GIK, although there was a slight increase in blood flow to the centre of the infarct. We concluded that GIK did not reduce infarct size in this experimental model.

Failure of high doses of propranolol to reduce experimental myocardial ischemic damage.

Myocardial creatine phosphokinase (CPK) activity and myocardial blood flow (MFB, 15 +/- mu microspheres) were measured at 24 hours after ligation of the left anterior descending coronary artery in nine untreated anesthetized dogs, in eight dogs pretreated with intravenous propranolol 5 mg/kg and in eight which had both pretreatment as well as infusion of propranolol (1.25 mg/kg/hour) after occlusion. Loss of CPK activity from the border and center zones of the myocardial infarct was similar in extent in dogs which had pretreatment but no infusion of propranolol as it was in the control group. Loss of CPK from the center zone was greater (P less than 0.005) in dogs receiving pretreatment followed by constant infusion of the drug. Propranolol had no significant effect on collateral blood flow to the border or center zone of the infarct. In separate experiments, there was no important difference in hemodynamic measurements, except a slower heart rate (P less than 0.01), when pretreated dogs were compared with control dogs up to 2 hours after coronary ligation. We conclude that propranolol given in this dose does not influence nyocardial damage, on the basis of regional myocardial blood flow or tissue CPK depletion values at 24 hr after coronary occlusion.

The effect of verapamil on experimental myocardial ischaemia with a particular reference to regional myocardial blood flow and metabolism.

The effects of verapamil on epicardial ST segment elevation, regional myocardial metabolism and collateral blood flow were studied in open-chest anesthetized dogs following left anterior descending coronary artery occlusion. Collateral blood flow was measured by radioactive microspheres (15 +/- 5 micron diameter) and regional metabolism was studied by measuring lactate concentration in venous blood draining the infarcting myocardium. Verapamil (0-2 mg/kg intravenously) produced a significant reduction (50-60%) in the epicardial ST elevation when it was given before coronary occlusion; when administered 15 minutes after coronary occlusion and infusion continued for two hours, it minimized (30-40%) ST segment elevation, and prevented the fall in cardiac index and rise in systemic resistance found in the untreated animals in which the ST segment remained persistently elevated. Changes in epicardial ST segment occurred without alterations in the QRS duration. Verapamil had no effect on either the total collateral blood flow or the relative distribution of flow to the endocardial and epicardial halves of the ischemic ventricular myocardium. No significant differences were found between the levels of lactate in blood sampled from small epicardial veins at the center of the infarct when the control animals were compared with those treated with verapamil.

The effect of splenectomy on circulatory adjustments to hypoxaemia in the anaesthetized dog.

Six intact and seven splenectomized dogs were subjected to a similar degree of hypoxaemia while under light anaesthesia and artificial ventilation. In the intact animals, heart rate, cardiac output, myocardial contractility and oxygen consumption were increased as a result of hypoxaemia; oxygen transport was not affected. In the splenectomized animals the changes in cardiac output and myocardial contractility were small, and oxygen availability was decreased.

The effects of isoprenaline on epicardial ST-segment elevation, lactate production, and myocardial blood flow following coronary artery ligation.

Isoprenaline was infused at low and high rates into anaesthetized dogs after ligation of the left anterior descending coronary artery, the resultant changes in epicardial ST-segment elevation being compared with lactate production and myocardial blood flow in the infarcting myocardium. Although ST elevation was increased at both infusion rates, there was no change in the arterial-local coronary venous difference of lactate concentration nor in myocardial blood flow at the centre of the infarct. The results suggest that the relationship between epicardial ST-segment elevation and other indices of ischaemic myocardial injury is complex and requires further evaluation.