Results of treatment of patients with maxillary sinus carcinoma.

BACKGROUND: Information regarding results of treatment and possible prognostic factors in patients with maxillary sinus carcinoma is limited. METHODS: Between 1969-1995, 48 consecutive patients presented to the study department for curative treatment of maxillary sinus carcinoma. Tumor classification according to the American Joint Committee on Cancer staging system was T1 in 1 patient, T2 in 6 patients, T3 in 17 patients, and T4 in 24 patients. The N classification was NO in 43 patients, N2a in 1 patient, N2b in 3 patients, and N2c in 1 patient. Treatment to the primary site was comprised of surgery (Sx) and radiation therapy (RT) in 37 patients and RT alone in 11 patients. RESULTS: There was a difference in disease free survival between patients who underwent Sx + RT compared with patients who received RT alone; combined therapy results were more favorable. The most common pattern of recurrence was in the primary site, which was found in 22 of 48 patients (45.8%). For patients who underwent Sx + RT, local control at 3 and 5 years was 65.2% and 59.2%, respectively; for patients who received RT alone, local control at both 3 and 5 years was 22.7%. There were 12 late complications found in 8 patients: fistula formation (5 patients), trismus (3 patients), osteonecrosis (1 patient), retinopathy (1 patient), cellulitis (1 patient), and nasal stenosis (1 patient). CONCLUSIONS: The type of treatment to the primary site is an important determinant of disease free survival and local control. Failure at the primary site is the main problem in the curative treatment of patients with maxillary sinus carcinoma; efforts to improve survival in these patients should be directed toward improvement of local control.

Factors that influence biochemical failure after radiation therapy for stage T1c prostate cancer.

More patients are now being diagnosed with nonpalpable prostate cancer after a needle biopsy is performed for an elevated prostate-specific antigen (PSA) level (stage T1c). The purpose of this study was to identify prognostic factors that are associated with biochemical failure after definitive external beam radiation therapy. This study included 75 patients with the diagnosis of T1c prostate cancer who were referred to four radiation oncology centers in the West Chicago area from 1992 to 1995. All patients were treated with megavoltage external beam radiotherapy to doses between 66 and 70 Gy. Biochemical failure was defined as three consecutive rising PSA values of at least 10% of the prior reading in posttreatment serial measurements. The mean age of the patients was 72 years. The mean follow-up was 1.7 years (range, 1-3 1/2 years). Of the 75 patients, 72 (96%) are clinically with no evidence of disease, three of the 75 are alive with disease, and 60 (80%) remain biochemically free of disease (bNED). The significant factors for bNED status were an initial PSA level of <15 ng/ml (p = 0.0001), achievement of a posttreatment nadir PSA level of < or = 1.5 ng/ml (p = 0.0001), and a Gleason score of <6 (p = 0.034). Multisextant involvement with tumor or bilobar disease was not significant. On multivariate analysis, an initial PSA level of <15 ng/ml (p = 0.0001), Gleason score of <6 (p = 0.02), and nadir PSA level of < or = 1.5 ng/ml (p = 0.03) were significant predictors of bNED survival. Men with T1c prostate cancer comprise a heterogeneous group. Patients with a high PSA level (>15 ng/ml) and high Gleason score (>6) are at increased risk for biochemical failure. Failure to achieve a posttreatment nadir PSA level of < or = 1.5 ng/ml is a predictor of ultimate biochemical failure.

Nursing postvention for spousal survivors of suicide.

There is a scarcity of information available with respect to postbereavement outcomes for survivors of the suicide of a loved one. Few studies have focused on postvention therapies for the bereaved, particularly the bereaved survivors of suicide. The major aim of this study as to compare the effects of two theoretically derived nursing postventions, Bereavement Group Postvention (BGP) and Social Group Postvention (SGP), among the widowed whose spouses died of suicide. The findings suggest that both groups experienced an overall reduction in depression and distress. Although participants in the SGP generally showed significant improvement in social adjustment, they tended to be less well adjusted with respect to their parental roles at the end of the 8-week postvention sessions. Comparison of the psychoemotional correlates of grief varied such that there were no significant differences between the postvention groups for social isolation, loss of control, somatization, or death anxiety. The BGP participants experienced significantly reduced levels of anger/hostility and guilt; however, feelings of anger/hostility actually increased for those receiving the SGP. There was a significant reduction in feelings of despair, rumination, and depersonalization for both groups. Although social isolation was not significantly reduced for participants in either group, those receiving the BGP tended to experience a reduction in social isolation and those receiving the SGP showed no changes.

Social support as experienced by Roman Catholic priests: the influence of vocationally imposed network restrictions.

This qualitative descriptive study explored the experience of social support as perceived by four Roman Catholic priests who are community caregivers subject to role-related stressors and who have vocational limitations placed on their social support networks. The data collection process consisted of two semistructured interviews employing open-ended questions. Content and concept analysis techniques yielded seven core themes (person-role disharmony, intimate connections, network leveling, moving networks, caregiver survival, vocation-person esteem, caring relationships), three prevailing themes (subsistent relationships, person-priest being, reciprocal fulfillment), and one contextual theme (presence). The priests actively sought support as a means of coping with the daily stress associated with their caregiving roles. Large and diffuse networks were unable to compensate for restrictions resulting from vows of celibacy, discord accompanying midlife transition, or conflicts associated with socially prescribed role expectations of the priesthood. The instability of their support networks resulting from mandatory transfers may have been a contributing factor. Existential presence, an enduring theme, was identified as an inherent quality of caregiving and social support.

Acute cholesterol responses to mental stress and change in posture.

BACKGROUND: Serum lipid levels vary widely within individuals, but the causes of these fluctuations are poorly understood. One area of research concerns elevations in cholesterol concentration in response to emotional stress. In a laboratory-based experiment, we compared the effects of acute mental stress and postural change (standing) on serum cholesterol concentration. In addition, plasma volume was indirectly monitored to determine whether cholesterol changes with mental stress, if present, were a function of hemoconcentration. METHODS: Twenty-six men attended two laboratory sessions, each consisting of baseline (30 minutes), task (20 minutes), and recovery (30 minutes) periods. Subjects rested in the supine position during the baseline and recovery periods. During the task period of one session, subjects performed a mental task (Stroop test and mental arithmetic); during the other session, the subjects stood for the task period. RESULTS: Both mental stress and standing elicited significant elevations in heart rate, blood pressure, and plasma catecholamine concentrations, relative to the baseline and recovery periods. Both the mental and orthostatic tasks also significantly increased serum cholesterol concentration (by 0.10 and 0.57 mmol/L [3.7 and 21.9 mg/dL], respectively), as well as hemoglobin level and hematocrit. Cholesterol elevations with standing were reversible, while those resulting from mental stress persisted through the recovery period. When values were corrected for concomitant hemoconcentration, no net change in serum cholesterol level occurred during either task. CONCLUSIONS: Acute mental stress can produce rapid elevations in serum cholesterol concentration. It can also increase hemoglobin concentration and hematocrit (ie, reduce plasma volume). Therefore, increases in serum cholesterol level after acute mental stress are analogous to those with standing and may reflect hemoconcentration rather than altered lipoprotein metabolism.