ABSTRACT
A limited body of evidence suggests that sleep problems are common in prostate cancer patients undergoing androgen deprivation therapy, yet little is known about sleep characteristics and the effects of poor sleep on daily functioning in this population. This study assessed sleep in 60 prostate cancer patients taking androgen deprivation therapy with wrist actigraphy and daily diaries for 7 days. The Epworth Sleepiness Scale and the general version of the Functional Assessment of Cancer Therapy scale were also administered. On average, total sleep time was 5.9 (SD = 1.4) h, and sleep efficiency was 75% (SD = 12.0) as assessed by actigraphy. There was generally poor concordance between actigraphy and daily diary for most sleep metrics. Subjects reported awakening, on average, 2.7 times per night, most commonly for nocturia and hot flashes. Assessment of daily functioning showed that participants had mild daytime sleepiness, which was predicted by total sleep time (F(1,47) = 4.5, P= 0.04) General quality of life was not impaired. This study supports more research on the predictors of poor sleep in order to identify effective interventions.
Subject(s)
Androgen Antagonists/adverse effects , Prostatic Neoplasms/drug therapy , Quality of Life , Sleep Wake Disorders/chemically induced , Aged , Aged, 80 and over , Androgen Antagonists/therapeutic use , Hot Flashes/chemically induced , Humans , Male , Middle Aged , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
In this lecture I will discuss the history of medicine and surgery in ancient China and India, and examine the value systems underpinning medical and surgical practice in these two civilizations. I will touch on some of the enduring "Asian" values that may be abstracted from the past to ensure that modern medicine along with surgery remains first and foremost a moral activity that renders public service, and is practiced with compassion and altruism. I will outline briefly the spread of Western or allopathic medicine into Asia and the rest of the world. Finally, I will look at the challenges that confront us today with the intrusion of high technology and the market economy into the practice of our profession. I will show how this has fundamentally altered the way we practise medicine and surgery and the delivery of health care.
Subject(s)
General Surgery/history , China , History, 17th Century , History, 19th Century , History, 20th Century , History, Ancient , History, Medieval , Holistic Health/history , Humans , India , Preventive Medicine/historyABSTRACT
A radial forearm flap including a segment of the cortex of the radius, based on the distal pedicle of the radial vessels and the cephalic vein, was used to reconstruct an intercalated defect of the thumb in two cases. In one case it was used as an ipsilateral pedicle flap while in the other case it was used as a free microvascular flap. In both cases, the skin flap as well as the segment of bone survived in toto without any evidence of creeping substitution. The functional result was good in both cases. This flap provides thin skin of good texture together with bone for a one-stage reconstruction.
Subject(s)
Surgical Flaps , Thumb/surgery , Adult , Female , Giant Cell Tumors/surgery , Hand , Humans , Male , Middle Aged , Thumb/injuriesABSTRACT
Postburn nailfold retraction often results in nail deformity and loss of distal interphalangeal joint flexion. A technique of reconstruction of the nailfold using a proximally based transposition flap is described in a patient with postburn nailfold retraction of the left thumb, index and middle fingers.
Subject(s)
Burns/complications , Finger Injuries/complications , Nails, Malformed/etiology , Surgical Flaps , Adult , Contracture/etiology , Contracture/surgery , Female , Finger Joint/surgery , Humans , Nails, Malformed/surgeryABSTRACT
Anastomosis of the superficial radial nerve, the dorsal cutaneous branch of the ulnar nerve, or both to the distal cut end of a widely resected median nerve in monkeys was followed by successful sensory reinnervation of the thumb, index finger, and long finger within thiry-five to forty weeks. Success was ascertained by the presence of an intact anastomosis as observed grossly without any evidence of spontaneous regeneration of the median nerve. Reinnervation was confirmed by histological and histochemical reactions observed in the Meissner's corpuscles in the skin innervated by the median nerve. The demonstration of nerve fiber and the presence of normal specific and non-specific cholinesterase reactions exhibited by the Meissner's corpuscles in the cholinesterase preparations were considered the histological criteria for successful reinnervation. These histological and histochemical observations may explain the reported functional sensory recovery in clinical cases when similar nerve transfers were done.