"Prostate cancer is far more hidden ": Perceptions of stigma, social isolation and help-seeking among men with prostate cancer.

The purpose of this study was to provide in-depth insight into men's experiences of prostate cancer, specifically: perceived stigma and self-blame, social isolation, unmet need and help-seeking. A qualitative descriptive approach was used. Semi-structured interviews were undertaken with 20 men diagnosed with prostate cancer, and thematic analysis was undertaken. Some participants perceived a stigma associated with prostate cancer and cancer in general, which sometimes acted as a barrier to disclosure. Self-blame and internalisation of cause was not a prominent issue. Participants' descriptions of emotional distress, social isolation and anxiety demonstrated the impact of prostate cancer. Social isolation was most commonly reported as a physical consequence of treatment and/or side effects. Participants felt both support and ongoing care were limited at post-treatment. Most did not seek or receive help for emotional or psychosocial problems from a formal source due to anticipated awkwardness, autonomous coping, not burdening others, unwanted sympathy and retaining privacy. Prostate cancer can cause considerable emotional and social burden for some men, and many are unlikely to seek or receive help. Men, and their support networks, require active encouragement throughout diagnosis, treatment and follow-up to overcome barriers and access additional support, particularly for sexual, emotional and psychosocial issues.

Accuracy of Voxel-Based and Algebraic Formula-Based Methods in Quantifying Cerebral Aneurysm Volume by 3D-Rotational Digital Subtraction Angiography. An In-Vitro and In-Vivo Study.

SUMMARY: Accurate knowledge of cerebral aneurysm volume would be valuable in guiding the volume of embolized material required for optimal filling of an aneurysm sac and recording percentage volume filling. Algebraic volumes are frequently estimated by algebraic volume formulae. 3D digital subtraction angiography (DSA) aids endovascular treatment planning and yields volumetric data. Our aim was to define the accuracy of 3D-DSA in quantifying aneurysm volume using an automated voxel-based volumetric method (voxel volume method) and compare results to volumes calculated by ellipsoid and cylindrical algebraic formulae (algebraic volume method). We constructed 13 latex aneurysm moulds and measured their true volumes using a micropipette in-vitro. 3D-DSA was performed on contrast filled moulds and experimental volume estimated by both voxel and algebraic methods. In our in-vivo study we quantified the voxel and algebraic volumes from the 3D data sets of 75 cerebral aneurysms. The linear regression test provided correction values between voxel and algebraic methods. The in-vitro study showed that the voxel volume method was the most accurate (mean percentage deviation from true volume 3.7 +/- 3.5%; p=0.9). The ellipsoid method significantly underestimated - 11.2 +/- 13.6%; p < 0.05) and the cylindrical method overestimated (42.6 +/- 35.7%; p < 0.05) true aneurysm volume. Similar results were obtained in-vivo. While algebraic measurements could be corrected by an equation, the clinical usefulness of this equation is questionable due to the large volume range to achieve a 95% confidence interval. The voxel volume method is accurate in quantifying aneurysm volume. Aneurysms in-vivo do not conform to simple algebraic geometry. Aneurysm volume on 3D-DSA should be calculated by the voxel-based method and not by algebraic formulae.

Acute tears of the posterior cruciate ligament. Results of operative treatment.

The posterior cruciate ligament, situated near the center of the knee, functions as the basic stabilizer and is located close to the axis of motion. We diagnosed and repaired thirty-two consecutive acute tears of the posterior cruciate ligament associated with tears of medial or lateral-compartment ligaments, or of both. Of the twenty-nine knees that we could evaluate, twenty-three demonstrated a 2+ to 3+ positive abduction or adduction stress test done in maximum extension and a positive anterior drawer test done in maximum internal rotation, while only nine had a definitely positive posterior drawer test. In all knees we repaired the tears, using the medial meniscus as a graft in nine knees in which the repair of the posterior cruciate ligament did not produce immediate adequate stability at operation. Five to sixteen years after operation, twenty of these twenty-nine knees were available for evaluation. The objective results were good in thirteen, fair in four, and poor in three.

Spectral analysis of human inspiratory diaphragmatic electromyograms.

The inspiratory diaphragmatic EMG was recorded via esophageal electrodes in six normal subjects. The EMG and ECG signals were analyzed by power density spectral analysis, before and after band-pass filtering (20--1,600 Hz). The EMG spectrum was concentrated in the bandwidth 25--250 Hz. Electrode motion introduced a significant artifact only at low frequencies. The ECG spectrum was also concentrated at lower frequencies, but substantial power from the cardiac signal spilled over across most of the EMG spectrum. Band-pass filtering was therefore effective in minimizing the former but not the latter. Of the various power and frequency parameters used to quantitate the EMG spectrum, the most stable was the centroid frequency. This was reproducible within and between subjects, and was not affected by changing tidal volume or inspiratory flow rate.

Preliminary model for human lipoprotein metabolism in hyperlipoproteinemia.

A model is proposed for the metabolism of plasma lipoprotein apoproteins based on studies of a hyperlipoproteinemic subject who received 2.5 mCi[3H]leucine intravenously. Measurements included apoprotein specific activities (apo-B and apo-C) of very low density lipoprotein (VLDL) and of three low density lipoprotein (LDL) subspecies, Sf 17 LDL, Sf 10 LDL, and Sf 4 LDL. Activities of plasma albumin were also determined. The data were analyzed using a compartmental model and the SAAM computer program. A chain-like series of compartments were necessary to simulate plasma VLDL kinetics, suggesting a multistep delipidation process. The data are consistent with the notion that VLDL is the dominant LDL precursor. Two modes of conversion from VLDL to LDL are required. After partial delipidation some VLDL is converted to the Sf 17 LDL, while the remainder undergoes further delipidation before being converted to Sf 4 LDL, the major plasma LDL component. Some direct release of LDL into plasma had to be introduced to fit the data, about 24% of total LDL production. The three LDL subspecies follow a precursor-product relationship (Sf 17 leads to Sf 10 leads to Sf 4). The analysis also indicates that in using labeled leucine as a tracer, the slow exchange of leucine with the total body protein pool must be considered in trying to resolve the LDL subsystem and in the estimation of steady-state apoprotein levels. In view of the fact that the proposed model is based predominantly on the data from a single patient, no generalizations can be made about parameter values. The study is most valuable, however, in pointing out metabolic pathways not considered before and in calling attention to variables that must be considered in the design of experiments to study lipoprotein kinetics.

Effect of hypoxia on immediate ventilatory load response in dogs.

The effective elastance of the respiratory system (which has been previously shown to provide an index of the ability of the respiratory musculature to compensate rapidly for transient mechanical ventilatory loads) was measured in six hypoxic dogs to determine whether hypoxia hindered immediate load-compensatory mechanisms. The effective elastance value was computed from measurements of control tidal volume and the pressure developed at the airway opening during the first inspiratory effort following airway occlusion at FRC. The mean effective elastance was 197 cmH2O/l while the animals were breathing room air and did not change significantly when the animals were rendered hypoxic by reducing the inspired oxygen concentration, in five dogs, or by controlled hemorrhage, in two dogs. It was concluded that inasmuch as effective elastance measurements remain constant during hypoxia, the stability of ventilation is not significantly impaired in this situation.