The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer

OBJECTIVE

The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa.

DESIGN AND MAIN OUTCOMES MEASURES

Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6.

RESULTS

Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high.

CONCLUSION

The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.

Reshaping Egyptian funerary ritual in colonized Nubia? Organic characterization of unguents from mortuary contexts of the New Kingdom (c. 1550-1070 BCE)

Samples taken from the canopic jars of Djehutyhotep, chief of Tehkhet (Debeira), Lower Nubia, and local versions of Egyptian canopic jars from Sai, Upper Nubia, suggest that the materials used for mortuary ritual unguents in Nubia may have differed from those used in Egypt. Nubian samples consisted of plant gum and bitumen, whereas those from Egypt conformed to the standardizing black resinous liquid recipe used for mummification and other funerary rituals. However, there may be time frame issues to be considered as most samples analyzed from Egypt date to later periods. A standard black funerary liquid was used at Amara West, Upper Nubia, probably poured over a wrapped body, which might suggest that the gum and bitumen mixture was reserved for filling canopic jars, perhaps indicating that the use of canopic jars in Nubia differed from their use in Egypt. Evidence from the canopic jars of Djehutyhotep, local versions of canopic jars from Sai, and the sample from Amara West also indicate a source of bitumen that was not the Dead Sea, which was the main (although not only) source used in Egypt. The new results from the analysis of the Djehutyhotep canopic jars and previously published results from Sai point towards alternative ritual practices associated with local conceptions and uses of canopic jars in colonized Nubia. These samples and data from Amara West further reveal that the bitumen used in mortuary contexts in Nubia originated elsewhere than bitumen used in Egypt, which might have implications for our understanding of colonized Nubia as part of other trade networks independently from Egypt.

Changes over time in self-efficacy to cope with cancer and well-being in women with breast cancer: a cross-cultural study

OBJECTIVE

This study aimed to examine whether self-efficacy to cope with cancer changes over time in patients with breast cancer and whether these potential changes are similar across patients. It also aimed to examine whether these trajectories are related to patient psychological well-being and overall quality of life.

METHODS

Participants (N = 404) from four countries (i.e. Finland, Israel, Italy, and Portugal) were enrolled in the study few weeks after breast surgery or biopsy. Self-efficacy to cope with cancer was assessed at baseline, six and 12 months later. Well-being indices were assessed at baseline, 12 and 18 months later.

RESULTS

Using Latent Class Growth Analysis, two groups of patients were identified. The majority of patients reported high levels of self-efficacy to cope, which increased over time. For almost 15% of the patients, however, self-efficacy declined over time. Diminishing levels of self-efficacy to cope predicted worse levels of well-being. The pattern of self-efficacy changes and their relationships to well-being was consistent across countries.

CONCLUSION

Monitoring self-efficacy to cope with cancer is probably important in order to detect alarming changes in its levels, as a declining self-efficacy to cope may serve as a signal of the need for intervention to prevent adaptation difficulties.

Abuse among Portuguese older people at a time of economic crisis recovery: findings from the Harmed study

This study aimed to assess the prevalence of abuse against Portuguese older people after an economic crisis and to assess how it has influenced health. A cross-sectional study was carried out including 677 older adults (≥60 years) during 2017. Results show that overall, 23.9% of older people reported being a victim of abuse in the last 12 months. The prevalence of psychological abuse was 19.9%, financial abuse 5.8%, physical abuse 2.5% and sexual abuse 1.9%. Older people who report abuse were more likely to have perceived insufficient income and low social support. The abuse was also significantly associated with poor health status and depressive symptoms. Even in an auspicious period, more than a fifth of older people experiences abuse which is associated with social and health vulnerabilities. These results support that an investment should be made in terms of policies toward an age-friendly environment.

Cirurgia paliativa do ombro em paralisia obstétrica do plexo braquial

A paralisia obstétrica do plexo braquial é rara originando disfunção grave e défice marcado da rotação externa e da abdução do ombro. Reviram-se retrospectivamente 11 casos de paralisia obstétrica do plexo braquial (sete com paralisia alta e quatro com paralisia completa) tratados cirurgicamente pela técnica de L’Épiscopo modificada por Hoffer. Estes resultados foram padronizados segundo o tipo de lesão (grupo A – lesão alta; grupo B – lesão completa) e a idade (grupo I ≤ 4 anos; grupo II > 4 anos). O seguimento médio foi de 35 meses. A idade média aquando da cirurgia era de 6,5 anos (r= 2–11). Todos, excepto um, apresentaram melhoria funcional, com aumento da pontuação média de Mallet de 4,6 pontos. Os dois subtipos de paralisia tiveram pontuação média de Mallet sobreponível (grupo A – 4.6; grupo B – 4.7); a idade aquando da cirurgia não influenciou o resultado clínico (pontuação média (grupo I) – 4.8; (grupo II) – 4.4). Não foram registadas complicações. A técnica de L’Épiscopo modificada por Hoffer é eficaz no tratamento paliativo do ombro em paralisia obstétrica do plexo braquial, permitindo recuperação da abdução e rotação externa do ombro. Está indicada em paralisias altas e completas, quando associada a outras cirurgias de recuperação da função do cotovelo, punho e/ou mão. Idade superior a 4 anos não contra-indica a cirurgia desde que sejam excluídas alterações da articulação glenoumeral.

[Ankle arthroscopy in treatment of Bosworth fracture]

The Bosworth fracture is a pattern of fracture-dislocation of the ankle joint with fixed dislocation of the proximal part of the fibula behind the posterior malleolus. It is a rare injury, which requires high index of suspicion for diagnosis. Fixed dislocation of the fibula does not allow for closed reduction, so open reduction and fixation of fibula or tibia is required. We present a case report of a patient who suffered a Bosworth fracture, with associated medial malleolus fracture. She underwent surgical treatment with open reduction and internal fixation of the fibula and tibia. We also performed anterior arthroscopy of the ankle, to evaluate the tibiofibular syndesmosis, remove loose osteochondral fragments, and perform debridement and microfracture of unstable chondral lesions of the talus. One year after injury, she remains with occasional pain and a normal range of motion comparing to the contralateral ankle joint. Bosworth fracture is a serious and rare injury, which requires early diagnosis and urgent surgical treatment. Performing ankle arthroscopy in the acute treatment of the Bosworth fracture allows for diagnosis and treatment of associated intra-articular injuries, as well as assisting with adequate fracture reduction and evaluation of the tibiofibular syndesmosis stability.

[Impact of foot reconstruction surgery on the daily life of patients with cerebrovascular accident sequelae]

OBJECTIVE

The equinovarus deformity of the foot and digital scrolling is very common among people with sequelae from cerebrovascular accidents. The aim of this study was focused on changes produced by surgical correction of the deformity in terms of comfort, balance, independence and ability to move freely within the context of the daily life of the patient.

MATERIAL AND METHODS

The data was evaluated using a retrospective survey and a prospective analysis of gait habits using a recording walking device (WalkinSense(®)) before and after surgery. All the 15 patients enrolled in the study were submitted to similar surgical procedures of lengthening and tendon transfers.

RESULTS

The use of technical aids to correct the deformity and to aid in walking, as well as painful calluses and difficulties with the shoes and walking on uneven surfaces, decreased significantly. Quantitative analysis of the gait showed that after surgery the patient started to move with smaller steps, although with a higher cadence. Gait analysis also revealed a decrease in the amount of gait segments and speed.

DISCUSSION AND CONCLUSIONS

The results showed a positive development in terms of indicators of comfort, balance, independence and self-image through surgery. However the new way of walking seems to be more tiring for the patients, which could justify a decrease in the number of gait segments and speed.

Metastatic carcinoma as an unusual cause of failure in total hip arthroplasty

Evaluation of osteolysis after total hip arthroplasty remains a challenge. It may reflect a myriad of problems: from wear-debris induced lesions to infection, metabolic bone disease or even malignant infiltration. We present the clinical, radiographic and pathological features of a 64-year-old woman in whom loosening and failure of total hip arthroplasty occurred secondary to a periacetabular metastasis from a previously undiagnosed lung carcinoma.

Clinical and radiological results following radial osteotomy in patients with Kienböck’s disease

Radial osteotomy is currently advocated for patients with Lichtman’s stages II and IIIA of Kienböck’s disease; its place in the treatment of patients with stage IIIB disease remains controversial. The purpose of this study was to evaluate the medium-term results of this procedure and to compare the outcome in patients with stage IIIB disease and those with earlier stages (II and IIIA). A total of 18 patients (18 osteotomies) were evaluated both clinically and radiologically at a mean follow-up of 10.3 years (4 to 18). Range of movement, grip strength and pain improved significantly in all patients; the functional score (Nakamura Scoring System (NSSK)) was high and self-reported disability (Disabilities of Arm, Shoulder and Hand questionnaire) was low at the final follow-up in all patients evaluated. Patients with stage IIIB disease, however, had a significantly lower grip strength, lower NSSK scores and higher disability than those in less advanced stages. Radiological progression of the disease was not noted in either group, despite the stage. Radial osteotomy seems effective in halting the progression of disease and improving symptoms in stages II, IIIA and IIIB. Patients with less advanced disease should be expected to have better clinical results.

Artoplastia trapeziometacarpiana tipo «ball-and-socket». Resultados a médio prazo

O objectivo deste estudo foi determinar os resultados a médio prazo de uma artroplastia retentiva da base do polegar utilizada para o tratamento da artrose trapezio-metacarpiana (TMC).

Reavaliamos clínica e radiograficamente 20 polegares (20 doentes) com um seguimento médio de 45 meses (R = 57-30).

Utilizando a pontuação de Buck-Gramko concluímos que funcionalmente 19 dos 20 doentes apresentavam um resultado considerado bom ou excelente. A avaliação da força e da mobilidade revelou resultados muito aproximados dos obtidos na mão não intervencionada.

A revisão radiográfica demonstrou a existência de áreas de osteólise rodeando o componente trapeziano em 2 casos, e extensas ossificações envolvendo a neo-articulação em dois casos adicionais.

Na nossa série registamos a presença de 4 complicações: duas fracturas do trapézio, uma luxação e uma perturbação sensitiva transitória.

A prótese trapézio-metacarpiana tem vindo a ganhar progressivamente mais adeptos, pois é clinicamente uma solução muito vantajosa devolvendo ao paciente uma articulação livre de dor, móvel e estável que lhe permite o rápido regresso a bons níveis de actividade e bem estar.

Contudo os achados radiográficos da nossa série levam-nos a recomendar a manutenção de uma atitude prudente e vigilante sobre estes casos que tem vindo a ser submetidos a artroplastias da TMC.

Shoulder arthrodesis in adult brachial plexus injury: what is the optimal position?

Brachial plexus injuries are a major indication for shoulder arthrodesis. However, there is no consensus concerning the optimal position of the glenohumeral joint for fusion. Between 1997 and 2008, 19 shoulder arthrodeses were performed using pelvic reconstruction plates. The radiographic and functional characteristics of 13 patients of mean age 46 years were examined at a mean of 101 months after arthrodesis. Arthrodeses showed 30° mean angle of abduction, 32° forward flexion and 44° internal rotation of the humerus with respect to the scapula. Abduction >35° and forward flexion ≥30° seem to offer slightly better functional results. Internal rotation ≤45° significantly relates to better ability of the hand to reach the face (p = 0.012). Neither abduction >35° nor forward flexion ≥30° showed a higher prevalence of periscapular pain. Abduction around 35° and forward flexion around 30° are needed for good functional results. Internal rotation should not exceed 45°.

Artroplastia total do punho na artrite reumatóide. Resultados dos primeiros 11 doentes operados

Sendo a artrite reumatóide, a principal indicação para a artroplastia total do punho, pretendemos com o este estudo, analisar a experiência com os implantes utilizados na nossa instituição. Avaliamos retrospectivamente 12 próteses colocadas em 11 doentes, utilizando a Universal 2 em 8 casos e a ReMotion em 4. Com um seguimento médio de 33 meses (rango = 15-59), obtivemos melhoria significativa da dor em todos os doentes; registamos incremento das amplitudes articulares e força, em média de 5,8º na flexão, 15,7º na extensão, 3,3º no desvio radial, 6º no cubital, de 22º na pronação, 26º na supinação e 5,4 e 1 kg para força de preensão da mão e de pinça. O DASH, avaliado na maioria dos doentes, teve melhoria média de 19 pontos. Como complicações houve um hematoma e uma deiscência com necrose dos bordos da ferida cirúrgica; um caso revelou sinais de descelamento do componente radial, no entanto sem repercussões significativas no resultado clínico e não registamos instabilidades. Até à data, nenhum doente foi reoperado. A artroplastia total punho revelou-se um procedimento eficaz no tratamento da artrite reumatóide, com uma baixa taxa de complicações. Apesar de não possuirmos tempo de evolução a longo prazo, os implantes revelaram uma fixação estável ao osso na grande maioria dos casos.

Detection of bacterial DNA in acute and chronic cholecystitis

BACKGROUND

The incidence of bacterbilia in cholelithiasis remains controversial. The positivity of cultures ranges from 0 to 73 per cent. The aim of this study was to employ the polymerase chain reaction (PCR) to detect bacterial DNA in gallbladder bile extracted during elective laparoscopic cholecystectomy, and to compare PCR findings with those of bile culture.

METHODS

Bile samples from 84 laparoscopic cholecystectomies were collected for culture and PCR analysis.

RESULTS

Positive results for bacterbilia were found in 42 (50 per cent) of 84 patients by PCR but in only 16 patients (19 per cent) by culture (P < 0.001). Agreement between the two methods was seen in 44 samples (52 per cent), which were negative in 35 cases. Pathological examination showed chronic cholecystitis in 69 cases (82 per cent) and acute cholecystitis in 15 (18 per cent). Thirty-three (48 per cent) of the patients with chronic cholecystitis were PCR positive but only ten (14 per cent) were culture positive (P < 0.001). Only culture results correlated with findings on pathological examination (P = 0.033).

CONCLUSION

PCR is more sensitive in detecting bacterial contamination of gallbladder bile in cholecystitis than conventional culture. The clinical relevance of this high sensitivity remains unclear.

[Cervical lymphadenopathy as first manifestation of a bronchogenic cyst]

A 26-year old woman was admitted with clinical and laboratory signs and symptoms of chronic infection and multiple cervical lymphadenopathy, whose pathological studies disclosed a non-specific inflammatory reaction. Anti-tuberculosis treatment was then started, with no significant improvement. Chest CT scans was compatible with a mediastinial tumor and RMN studies revealed the presence of an infected bronchogenic cyst, which was surgically and successfully removed with complete disappearance of the infection. The authors conclude by enhancing the fact that bronchogenic cysts may course with diverse clinical manifestations and should be included in differential diagnosis of mediastinal tumors.

[Terminolateral esophagojejunostomy after gastrectomy with the biofragmentable anastomosis ring in the dog model]

INTRODUCTION

Esophagojejunostomy after total gastrectomy still remains a high risk anastomosis with a considerable morbidity and mortality. The majority of these anastomoses are performed by the intraluminal stapler technique, yet stenoses are a known late complication even after an uneventful postoperative course. In the present study, the osophagojejunostomy with the biofragmentable anastomosis ring (BAR) was examined in dogs.

METHODS

28 dogs were randomized into a group of manual suture (n = 14) and a BAR-group (n = 14). After gastrectomy, the esophagojejunostomy was performed by hand-suture with polypropylene 4-0 in the manual suture group, and with the 25/1.5 mm BAR in the BAR-group. In both groups the Roux-en-Y jejunojejunostomy was performed by hand-suture. The dogs were evaluated on postoperative days 4, 7 and 14 with regard to macroscopy, bursting strength, tissue hydroxyproline and histology.

RESULTS

There was one leakage without clinical effect in the hand-sewn group on postoperative day 4; there was no leak in the BAR-group. In observing fibre-free enteral feeding, neither functional disorders nor obstruction of the BAR were observed. The general anastomosis parameters were matchable between the groups.

CONCLUSION

The infracarinal BAR-esophagojejunostomy is comparable to the hand-sewn anastomosis in the dog-model.

Evaluation of carboxymethylcellulose, hydroxypropylmethylcellulose, and aluminum hydroxide as potential carriers for rhBMP-2

Conventional iliac crest nonvascularized corticocancelous bone grafts and bone flaps have been used to treat bony defects. However, these treatments have some limitations, namely, the availability of donor tissue, donor site morbidity, difficulty to shape the bone flap to the defect, and complexity of the surgery. The bone morphogenetic protein (rhBMP-2) is osteoinductive. However, its implantation requires a matrix (carrier) in order to define the shape of the resulting bone and to retain the protein at the site for the time required for induction to occur. When the ideal carrier is found, an unlimited supply of material would be available for all applications where bone is needed. In this in vitro study, we evaluated the suitability of some potential carriers for rhBMP-2 by measuring the alkaline phosphatase (ALP) activity of fibroblast cultures. Either rhBMP-2 or sodium carboxymethylcellulose significantly increased the ALP activity, when used alone. When sodium carboxymethylcellulose was combined with rhBMP-2, there was an increase in the ALP activity, but lower than those obtained when the products were used alone. Hydroxypropylmethylcellulose alone did not affect ALP activity. However, the combination of rhBMP-2 with hydroxypropylmethylcellulose did not increase the ALP activity, despite the presence of rhBMP-2. Aluminium hydroxide proved to be an unsuitable rhBMP-2 adsorbent.

Retinal detachment in young premature infants with acute retrolental fibroplasia. Thirty-two new cases

Experience with scleral buckling for exudative and tractional retinal detachments in very young premature infants who have acute retrolental fibroplasia (RLF) is reported. In this series, surgery was successful in 24 of 32 eyes (75%) of 23 infants, (age at surgery ranged from 1.75 months to 6 months, average age of 3 months). We attribute the 15% improvement in the success rate over our 1979 series in part to closer screening with emphasis on the examination at age 8 weeks, to earlier referral for treatment, and to our observation that these fragile eyes can withstand reoperation if buckle revision is necessary to combat persistent retinal traction. We encountered no serious complications either at surgery or immediately after surgery. We stress that (1) because of the high incidence of spontaneous remission, buckling surgery should not be performed until the detachment has progressed well posterior to the equator and remission is obviously unlikely (Grade IV or V); (2) excessive cryotherapy and undue surgical trauma should be avoided; and (3) because scleral erosion is certain as the eyes grow, the encircling band should be transected six months to one year after surgery.

[Epidermoid carcinoma of the stomach]

A case of pure squamous cell carcinoma of the stomach in a 63-year-old woman has been reported. The tumor was located in pyloric antrum and histologic examination disclosed a well differentiated squamous cell carcinoma, with many horn pearls. Histogenesis of similar cases of this unusual tumor have been briefly discussed.