Qualitative study of return to work following breast cancer treatment.

BACKGROUND: After 5 years' sick leave in Brazil, employees must retire due to disability. The duration from breast cancer surgery to the end of treatment should be ~9 months. However, diagnosis alone can take 6 months. Surveys administered soon after returning to work have highlighted problems regarding the slow speed of the treatment process and lack of protective legislation. AIMS: To assess the barriers and facilitators experienced and the coping strategies adopted by Brazilian women 30 days after return to work following breast cancer treatment. METHODS: A qualitative study of 12 women treated for breast cancer. The interviews were recorded, transcribed verbatim and independently analysed by two researchers using a standardized method of analysis. RESULTS: Women took an average of 583 days to return to work following breast cancer treatment. The return-to-work experience was considered good, with the physical barriers being fatigue and problems with the arms, and the work environmental barriers being related to discrimination from employers and overprotection from colleagues. Facilitators included social and emotional support given by colleagues/relatives/employers and jobs requiring more cognitive effort than physical exertion. Coping strategies were related to job role adjustments and reduction in tasks and working hours. CONCLUSIONS: Results were similar to those reported by previous studies, with the exception of the facilitators. Cognitive effort is commonly considered a barrier. However, the present study had an unusually long duration before return to work, possibly reducing the acute effects of chemotherapy on cognition.

[Partial sphincterectomy in cataract surgery. Clinical and patho-histologic results]. / Partielle Sphinkterektomie in der Kataraktchirurgie. Klinische und pathohistologische Ergebnisse.

BACKGROUND: We perform partial sphincterectomy during cataract surgery in cases with very small pupil (< 3 mm). We assume that the small pupil is mainly due to a fibrosis ring of the sphincter muscle. PATIENTS: In 35 patients we performed the complete ophthalmological routine checkup. The pupil diameter was analysed by perimeter: a base value, with light, and in pharmaceutical mydriasis. Moreover 15 preparations were analysed histologically. RESULTS: Average pupil diameter was: base value 3.76 mm, with light 3.24 mm, in pharmaceutical mydriasis 4.84 mm. The showed pathohistological examination that in all excisions a part of the sphincter muscle was verifiable. We found fibrosis of different grades in various locations. CONCLUSION: In most cases functional pupil movement can be verified after operation. In an intended partial sphincterectomy part of the sphincter muscle can be excised. The different pupil diameter is due to the different degree of fibrosis of the sphincter muscle.

[Cataract surgery in narrow pupil and postoperative fibrin reaction, especially after sphincterectomy]. / Kataraktchirurgie bei enger Pupille und postoperative Fibrinreaktion, insbesondere nach Sphinkterektomie.

BACKGROUND: Since increased intraoperative iris irritation can lead to increased postoperative inflammation, we are interested in postoperative reactions to several varied surgical procedures. We performed pupil stretching, iridotomy with iris suture, and partial sphincterectomy. MATERIALS AND METHODS: From January 1995 to January 1996, 100 patients (103 eyes) with narrow pupils underwent cataract surgery. In 13 eyes a iridotomy and iris suture were performed, in 28 eyes a partial sphincterectomy. In 62 eyes there was no surgical intervention after pupil stretching. Postoperative examinations were carried out in the early postoperative phase (up to 5 days postoperative) as well as 4 weeks after surgery. Fibrin reaction was classified according to 3 grades, (1) faint fibrinous threads, (II) fibrinous net, and (III) membranous fibrin exsudation. RESULTS: In the group without additional surgery there was a fibrinous reaction of grade I and II in 11 eyes. This complication occurred after iridotomy and iris suture in four cases and after sphincterectomy in four cases. While the intensity of fibrinous reaction was comparable in the first two groups, the fibrinous reaction after sphincterectomy was more intensive in one eye (grade III). However, response to intensive local antiphlogistic therapy was good. Frequency of fibrinous reaction in the three groups was statistically not significant. It should be pointed out that there was a partial restoration of pupil movements through sphincterectomy: mean pupil diameter was 4 mm, and 2.5 mm under exposure to light. Three patients had no pupillary reaction at all. CONCLUSIONS: Partial sphincterectomy facilities intraoperative manipulations of cataract surgery. Postoperative inflammatory reaction is rare and was very responsive to medical treatment. The reconstruction of pupillary movement is part of full visual function and, last but not least a round pupil is aesthetically more desirable.

[Minimizing astigmatism by controlled localization of cataract approach with the no stitch technique. A prospective study]. / Astigmatismusminimierung durch gezielte Lokalisation des Kataraktzuganges mit der No-Stitch-Technik. Eine prospektive Studie.

BACKGROUND: The no-stitch-technique with deliberate localisation of the cataract incision is a method to reduce the postoperative astigmatism. This prompted us to investigate the postoperative astigmatism with varying incision localisation; our aim is to achieve a postoperative astigmatism < or = 1.0 D. PATIENTS AND METHOD: In this study we controlled 319 eyes of 316 cataract patients. We took into consideration the preoperative astigmatism and operated in the 12 o'clock or lateral position. The astigmatism was measured by an ophthalmometer preoperatively, on the first day, after 3-5 months and 8-12 months after surgery. RESULTS: A preoperative astigmatism of up to < or = 1.0 D was present in 82.4% of eyes. On the first day after surgery an astigmatism of < or = 1.0 D was present in 89.3% of eyes. After 3-5 months postoperatively astigmatism was < or = 1.0 D in 97.2% and in 98.8% after 8-12 months postoperatively. 15.7% of patients showed a preoperative astigmatism between 1 and 2 D, but only 1.2% after 8-12 months. There was no astigmatism > 2.0 D after 3-5 months and 8-12 months (preoperative 2%). CONCLUSIONS: The no-stitch-technique permits to control the postoperative astigmatism with deliberate localisation of the cataract incision. Postoperative astigmatism appeared to be stable. We therefore recommend for preoperative "ATR (Against the rule)-Astigmatism" (> or = 1.0 D) operation in lateral position and for preoperative "WTR (With the rule)-Astigmatism" operation in the 12 o'clock position.

Metabolism of trinitrobenzene sulfonic acid by the rat colon produces reactive oxygen species.

Recent studies have shown that intrarectal administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) in ethanol or intramural injection of TNBS in saline produces an acute and possibly chronic colitis in rats. It has been assumed that interstitial TNBS initiates the inflammatory response via macrophage-mediated recognition and degradation of TNBS-modified mucosal cells and proteins. However, it is known that certain flavoproteins and/or reductants interact with compounds containing the nitro functional group to generate pro-inflammatory, nitrogen-centered free radicals and reactive oxygen metabolites. The objective of this study was to assess the ability of the rat colon, using either colon homogenates, isolated colonocytes, or intestinal interstitial fluid, to produce reactive oxygen species via enzymatic and/or nonenzymatic metabolism of TNBS. It was found that the addition of TNBS (1 mmol/L) to the 10,000 x g supernatant of rat colon homogenates increased the rate of superoxide production from normally undetectable levels to 2.6 +/- 0.23 nmol.min-1.mg protein-1. Addition of nicotinamide adenine dinucleotide, reduced form (NADH; 1 mmol/L) to colon homogenates containing TNBS significantly enhanced superoxide production to 10.4 +/- 0.9 nmol.min-1.mg-1. Similarly, addition of nicotinamide adenine dinucleotide phosphate, reduced form (NADPH; 1 mmol/L) to colon extracts containing TNBS produced an even further increase in the rate of superoxide formation to 25.2 +/- 1.1 nmol.min-1.mg-1. Addition of NADH or NADPH to the colon homogenate in the absence of TNBS produced no detectable superoxide formation, suggesting that TNBS was required for the enhanced oxidative metabolism. In a separate series of experiments, it was found that isolated colonocytes produced small but significant amounts of superoxide (3.15 +/- 0.6 nmol/2 x 10(6) cells) that were significantly increased in the presence of ethanol to 6.55 +/- 1.14 nmol/2 x 10(6) cells. Using purified preparations of two flavoproteins found in the rat colon, it was shown that the addition of TNBS (1 mmol/L) to purified NADH dehydrogenase or glutathione reductase increased the rate of superoxide formation by these enzymes from normally undetectable levels to 1.6 nmol/min and 1.2 nmol/min, respectively. In addition, it was found that intestinal interstitial fluid (lymph) initiated redox cycling of TNBS such that 28.1 +/- 1.6 nmol of oxygen was consumed per minute per milliliter of lymph. This increase in oxygen consumption was inhibited by the addition of superoxide dismutase and catalase. One possible metabolite involved in both mucosal and lymph-mediated metabolism of TNBS is ascorbic acid.(ABSTRACT TRUNCATED AT 400 WORDS)

The effects of sulfasalazine metabolites on hemoglobin-catalyzed lipid peroxidation.

Ulcerative colitis (UC) is a recurrent inflammation of the colon and rectum that is characterized by subepithelial hemorrhage, epithelial cell necrosis, infiltration of large numbers of phagocytic leukocytes (neutrophils, eosinophils, macrophages), and mucosal ulcerations. Recent evidence suggests that mucosal lipid peroxidation may play an important role in that pathogenesis of the inflammation-induced intestinal injury. Using hemoglobin (Hb)-catalyzed, H2O2-dependent peroxidation of phospholipid as a model of oxidative injury to membrane lipids, we assessed the ability of the anti-inflammatory drugs sulfasalazine (SAZ), olsalazine, and their metabolites, 5-aminosalicylic acid (5-ASA), N-acetyl-5-ASA, and sulfapyridine (SP) to inhibit this reaction. We found that Hb interacted with H2O2 to yield the radical and nonradical forms of ferryl Hb (Hb(V)) which were capable of initiating the peroxidation of a phospholipid. This interaction did not result in the peroxide-dependent release of iron from the hemoprotein. In addition, we demonstrated that the pharmacologically active moiety of SAZ (or olsalazine), 5-ASA, was significantly better at inhibiting the Hb-catalyzed peroxidative reaction. The concentration of 5-ASA required to inhibit lipid peroxidation by 50% (IC50) was determined to be 50 microM. Neither parent compound (SAZ, olsalazine) nor the pharmacologically inactive metabolite (SP) were effective in attenuating the lipid peroxidation at concentrations up to 100 microM. The N-acetylated derivative of 5-ASA was less effective as an inhibitor in this system possessing an IC50 of 100 microM. The mechanism by which 5-ASA inhibited lipid peroxidation appeared to be due to its ability to donate electrons to and thus scavenge the radical and nonradical forms of HB(IV).(ABSTRACT TRUNCATED AT 250 WORDS)

Dysphagia of the treated laryngeal cancer--detection of functional and morphological changes by cineradiography.

After treatment of laryngeal cancer 35 patients with dysphagia have been examined by high speed cineradiography. When compared to normal swallowing patterns, the following abnormalities were observed: Excursion of the posterior pharyngeal wall during swallowing is twice as intensive as normal. The function of the base of the tongue becomes more important for pharyngeal emptying--a fact that surgeons should take into consideration when planning laryngeal resection. Timing of pharyngeal constriction and function of the upper esophageal sphincter are definitively altered. In view of these changes we think that cineradiography can help to find better methods for functional surgery of the pharynx and the adjacent structures.