The effect of stuttering on symptoms of depression and social anxiety in adolescents.

OBJECTIVE: This study aims at examining the relationship between the severity of stuttering, which makes it difficult to speak and communicate, and the symptoms of depressive and social anxiety disorders during adolescence. PATIENTS AND METHODS: A total of 65 children between 14 and 18 years old, diagnosed with stuttering, were included in the study, regardless of gender. Stuttering Severity Instrument, Beck Depression Scale, and Social Anxiety Scale for Adolescents were administered to all participants. RESULTS: The mean age of the 65 patients was 15.41±0.93. Out of them, 36 (55.4%) were female and 29 (44.6%) were male. In terms of stuttering levels, 25 participants (35.8%) had mild stuttering, 20 (30.8%) showed moderate stuttering, and 20 (30.8%) had severe stuttering. Depression levels of individuals diagnosed with stuttering increased significantly in parallel with the severity of stuttering (p<0.001). The social anxiety scale total score and subscale scores of individuals diagnosed with stuttering also increased significantly in parallel with stuttering severity (p<0.01). CONCLUSIONS: The symptoms of depression and social anxiety disorders increase with the severity of stuttering in adolescent patients who applied to the child psychiatry clinic presenting stuttering.

Is social appearance anxiety a reason for rejecting a hearing aid in geriatric patients?

OBJECTIVE: Hearing impairment is a global health problem due to its impact on quality of life and communication problems between individuals. Hearing aids are the recommended intervention, but use of hearing aids is low. In this study, the effect of social appearance anxiety on the decision to use a hearing aid was investigated. PATIENTS AND METHODS: The study comprised 107 individuals aged 65-81 years who were offered hearing aids due to bilateral severe or moderate sensorineural hearing loss. The patients were divided into three groups, according to their hearing aid preferences and usage decisions. Social appearance anxiety scale was applied to all patients. RESULTS: The mean age of the 107 patients included in the study was 70.19±5.35 years. The social appearance anxiety scores of those who did not want to use a hearing aid were much higher than those of whom desired to use a behind-the-ear or in-canal hearing aid. The social appearance anxiety scores of the patients who wanted to use in-canal hearing aids were also higher than the group who wanted to use behind-the-ear hearing aids. CONCLUSIONS: In this study, which focused on the hearing aid candidate group who had never obtained a device, rather than why they stopped using a hearing aid, it was assumed that social appearance concern was relevant in the phase of receiving a hearing aid.

Weber's gland immune/histopathology in pediatric recurrent tonsillitis and obstructive tonsillar hypertrophy cases.

OBJECTIVE: Recurrent tonsillitis and obstructive tonsillar hypertrophy are very common in childhood and constitute the two major causes of tonsillectomy in this age group. There is no study in the literature on the immune/histopathological changes in the recurrent and obstructive tonsillar hypertrophy of Weber's glands. In this study, we aimed to histopathologically and immunohistochemically examine the Weber's glands of pediatric patients with recurrent. PATIENTS AND METHODS: A total of 63 patients, with 31 patients aged 6-9 who had surgery for recurrent tonsillitis, and 32 patients aged 6-11 years who had surgery for obstructive tonsillar hypertrophy, were included in the study. The removed Weber's glands were included in the obstructive tonsillar hypertrophy or recurrent tonsillitis group according to the patient's clinical diagnosis. All specimens were coded with a numbering method, where only the surgeon knew which patient was in which group. All specimens were evaluated in the same histology center and by the same histologist, unaware of the clinical diagnosis of the patients (blind). RESULTS: The comparison of Weber's gland immunohistochemical parameter scores of the groups revealed that the scores of the RT group were significantly higher for all three parameters (VEGF: t=6.777; p<0.001), (EGFR: t=4.386; p<0.001), (IL-6: t=5.072; p<0.001). The comparison of the groups in terms of inflammation, basement membrane thickening, myoepithelial cell and glycoprotein accumulation revealed significantly higher Weber's gland evaluation scores in the RT group for all four parameters. (inflammation: t=7.794; p<0.001), (basement membrane thickening: t=6.582; p<0.001), [myoepithelial cell: t=3.693; p<0.001), (glycoprotein accumulation: t=5.287; p<0.001)]. CONCLUSIONS: Histopathological and immunohistochemical examination of Weber's gland in pediatric recurrent tonsillitis and obstructive tonsillar hypertrophy cases revealed inflammatory changes in both disease groups. As expected, inflammatory manifestations were more common in the recurrent tonsillitis group. Besides, inflammatory changes detected in Weber's glands of obstructive tonsillar hypertrophy cases without a history of tonsillitis may contribute to the Weber's gland hypothesis, which attempts to explain the etiology of peritonsillar abscess.

Nurse-Led Phone Call Follow-Up Clinics Are Effective for Patients With Prostate Cancer.

INTRODUCTION: The rising cost of healthcare requires rethinking in terms of resource utilisation care delivery. Nurse-led PSA phone follow-up clinics may provide a suitable option. MATERIALS AND METHODS: 815 patients were recruited for the nurse-led stable prostate cancer telephone follow-up service. A convenience sample was selected for postal questionnaire assessment of their satisfaction. RESULTS: 815 patients had 3683 phone-call follow ups over 10 years. Patients' own understanding of condition varied from average (76.3%) and good (9.2%) in the majority. 87.2% found the service convenient and 75.6% informative. 95.3% found the telephone assessment preferable to attending the outpatient department. 87.2% were keen on savings on transport/travel. 53.5% found it more reassuring. 91.9% of patients felt that everything they wanted to talk about was covered. DISCUSSION: This service can be delivered in a high volume nurse-led service, with high levels of patient satisfaction, as an innovative service development.

Magnetic resonance based texture parameters as potential imaging biomarkers for predicting long-term survival in locally advanced rectal cancer treated by chemoradiotherapy.

AIM: The study aimed to investigate whether textural features of rectal cancer on MRI can predict long-term survival in patients treated with long-course chemoradiotherapy. METHOD: Textural analysis (TA) using a filtration-histogram technique of T2-weighted pre- and 6-week post-chemoradiotherapy MRI was undertaken using TexRAD, a proprietary software algorithm. Regions of interest enclosing the largest cross-sectional area of the tumour were manually delineated on the axial images and the filtration step extracted features at different anatomical scales (fine, medium and coarse) followed by quantification of statistical features [mean intensity, standard deviation, entropy, skewness, kurtosis and mean of positive pixels (MPP)] using histogram analysis. Cox multiple regression analysis determined which univariate features including textural, radiological and histological independently predicted overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). RESULTS: MPP [fine texture, hazard ratio (HR) 6.9, 95% CI: 2.43-19.55, P < 0.001], mean (medium texture, HR 5.6, 95% CI: 1.4-21.7, P = 0.007) and extramural venous invasion (EMVI) on MRI (HR 2.96, 95% CI: 1.04-8.37, P = 0.041) independently predicted OS while mean (medium texture, HR 4.53, 95% CI: 1.58-12.94, P = 0.003), MPP (fine texture, HR 3.36, 95% CI: 1.36-8.31, P = 0.008) and threatened circumferential resection margin (CRM) on MRI (HR 3.1, 95% CI: 1.01-9.46, P = 0.046) predicted DFS. For OS, EMVI on MRI (HR 4.23, 95% CI: 1.41-12.69, P = 0.01) and for DFS kurtosis (medium texture, HR 3.97, 95% CI: 1.44-10.94, P = 0.007) and CRM involvement on MRI (HR 3.36, 95% CI: 1.21-9.32, P = 0.02) were the independent post-treatment factors. Only TA independently predicted RFS on pre- or post-treatment analyses. CONCLUSION: MR based TA of rectal cancers can predict outcome before undergoing surgery and could potentially select patients for individualized therapy.

Laparoscopic total mesorectal excision following long course chemoradiotherapy for locally advanced rectal cancer.

PURPOSE: Laparoscopic total mesorectal excision (TME) of locally advanced rectal cancer after long-course chemoradiotherapy (LCRT) is surgically and oncologically challenging. We have assessed the feasibility, timing, and short-term oncological outcome of laparoscopic TME after LCRT. METHODS: Between 2004 and 2006, 30 patients were selected for LCRT based on clinical examination and MRI. Patients received 3/4 field radiotherapy, 45-50.4 Gy in 25-28 fractions during 5 weeks with either 5-fluorouracil or Uftoral. Clinical assessments were made 4 weeks after completion of radiotherapy and then 2 weekly with sequential 4 weekly MRI, to individualize the timing of surgery at maximal response. Laparoscopic TME was performed using a standard technique. RESULTS: Thirty patients received LCRT and 26 patients (21 men; median age, 63 years) underwent laparoscopic TME at 11 weeks (median) after LCRT. Median operating time was 270 min. Sixteen patients had LAR and ten had APR. There were three conversions. Three patients developed anastomotic leak (18.7%): one was managed conservatively and one patient died of septicemia. Morbidity was seen in 19% of patients. There were 25 (96%) R0 resections with a complete response in 5 (19%) cases and microscopic tumor in lakes of mucin (Tmic) in another 6 (23%). Two patients (7.6%) developed local recurrence (median follow up, 34 months). The median time interval between radiotherapy and surgery was 11 (range, 7-13) weeks, which was based on serial MRI scans after LCRT. CONCLUSIONS: Laparoscopic TME after LCRT is feasible and safe both oncologically and surgically. Serial MRI helps to determine the optimum timing of surgery.

Locally advanced rectal cancer: histopathological correlation and predictive accuracy of serial MRI after neoadjuvant chemotherapy.

The accuracy of MRI after long-course chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC) has been questioned. We have evaluated our experience of sequential MRI to assess pre-operative downstaging with histopathology correlation. 17 patients with LARC had three MRI scans: MRI 1, before treatment; MRI 2, 6 weeks post-CRT; and MRI 3, pre-operatively. MRI T and N staging were reported, with T3 subdivided into T3a (<5 mm through wall), T3b (1-5 mm), T3c (5-15 mm) and T3d (>15 mm). The maximal wall measurements and a prediction of vascular involvement were also correlated with histopathology. Histopathological agreement with MRI 3 was high: T 82%; N 88% and vascular 73%. Statistically significant (p<0.01) T downstaging was shown in MRI 2 and MRI 3 groups. In the 6 weeks post-CRT scan, T downstaging occurred in 6% of patients, with a further 29.4% showing T3c to T3b downsizing. 41% showed N stage improvement. In the third MRI group pre-surgery, 41.2% showed an MRI T stage improvement, with a further T3 downsizing in 17.6% of patients. 50% of these responders had shown no T stage improvement on their second scan. The sequential scans also showed significant reduction in wall thickness (p<0.01). In conclusion, the pre-operative MRI showed ongoing response to CRT up to 12 weeks post-CRT, which has important clinical implications regarding the most appropriate time to operate. Improved agreement between MRI 3 and histopathology compared with previous studies including only one post-treatment MRI was also demonstrated.

Information given to patients about adverse effects of radiotherapy: a survey of patients' views.

AIMS: In practice, clinicians vary markedly in the amount of information they give to patients before consent for investigation or treatment is obtained. We present a study to evaluate the amount of information patients feel that they should be given. MATERIALS AND METHODS: Between October 2001 and February 2002, 82 adults were enrolled into the study before commencing treatment with radiotherapy. Participants were interviewed with the aid of a questionnaire, and responses were analysed to detect differences related to age, sex, disease site, treatment intent and social class. RESULTS: The distribution of responses to the interview was large. For a mild side-effect, 23 patients (28%) wanted to be informed if the risk of the side-effect was as small as 0.1%, whereas 25 patients (31%) would only want to be informed if there was either a 50% or a 100% chance of it occurring. For severe side-effects, 36 (44%) wanted to be informed of a 0.1% risk, whereas 13 (16%) only wanted to be informed if the risk was either 50% or 100%. There was no association with sex, treatment intent (radical or palliative), social class or disease site. Information requirements tended to be greater in people under 60 years. This reached statistical significance (P = 0.007) for severe side-effects, where younger patients were more likely to want to be informed of a side-effect if there was a 10% or less chance of it occurring. CONCLUSIONS: Information needs varied widely within our survey population. It is difficult to predict how much information patients feel they need before giving informed consent. Therefore, a patient-centred approach must involve tailoring information to individual patient requirements.

Long-term follow-up of Anglian Germ Cell Cancer Group surveillance versus patients with Stage 1 nonseminoma treated with adjuvant chemotherapy.

OBJECTIVES: To study survival and late events after adjuvant chemotherapy in Stage 1 nonseminoma. METHODS: From 1978 to 1986, all patients had surveillance. From 1986, adjuvant chemotherapy (initially a 3-day regimen of etoposide, bleomycin, and cisplatin, but, more recently, bleomycin, Oncovin, and cisplatin) was offered to patients at a high risk of relapse (greater than 30%). RESULTS: A total of 382 patients with Stage 1 nonseminoma treated between 1978 and 2000 were reviewed. Of the 234 patients treated by surveillance, 71 (30%) had relapses (5 after 2 years), 6 died (2.6%) of germ cell cancer, and 3 developed second primary testicular cancer. Of the 148 men treated with adjuvant chemotherapy, 6 (4%) had relapses and 2 (1.4%) died of chemoresistant cancer. After one course of etoposide, bleomycin, and cisplatin, 3 (6.5%) of 46 developed a relapse; after two courses, 1 (3.6%) of 28 did so; and after bleomycin, Oncovin, and cisplatin every 10 days x2, 2 (2.7%) of 74 patients did so. Of the high-risk patients who were offered adjuvant treatment, 24% declined. As a consequence, the relapse rate of the surveillance patients only fell from 36% to 27% after the introduction of adjuvant therapy, although for the total cohort treated in the adjuvant era, the relapse rate was 16%. CONCLUSIONS: Adjuvant chemotherapy is more effective than retroperitoneal lymph node dissection for reducing the relapse risk in high-risk Stage 1 nonseminoma. However, given the uncertainty about the incidence of postchemotherapy late events, surveillance and retroperitoneal lymph node dissection remain justified alternatives. With positron emission tomography and laparoscopy showing increasing promise in these cases, quality-of-life studies and greater patient involvement in treatment selection are needed.