Biomedical subjects

L Klotz

Publications and source records attributed to L Klotz.

59 records · Page 4Linked to original sources

PubMedDate not supplied

Permanent flank bulge is a consequence of flank incision for radical nephrectomy in one half of patients.

The objective of the study was to determine the incidence and predictors of post operative pain and flank bulging in patients undergoing nephrectomy for a renal tumor through a flank or thoracoabdominal incision. Only one previous retrospective study (1974) has directly addressed this issue in urologic patients. This reported a 3% incidence of flank bulging. This was at variance with our own experience. To determine the incidence of pain and post-operative flank bulge after flank or thoraco-abdominal incision, a cross sectional survey among in 70 patients, who had a nephrectomy for a renal tumor between 1996 and 2000, was assessed by telephone interview. Four surgeons contributed patients to the study. Thirty-four of seventy (49%) patients complained of a flank bulge persisting more than 1 yr after surgery. Durable flank pain was experienced by 24%. This was severe in 3% of patients. Median pain magnitude was 5/10. There was no difference in bulge incidence between surgeons (P = 0.49). Flank bulging occurred more frequently in left sided nephrectomy (P = 0.054) than right. Other parameters including gender, age, and tumor size had no correlation with the rate of either complication. In all patients who described a flank bulge, the deformity was durable; there were no cases of spontaneous resolution. Patients described a significant impact on QOL, particularly in those under 60 yrs. The overall rate of postoperative flank bulging is considerably higher than has been previously reported. This deformity affects quality of life. The observation that almost 50% of patients experience a flank bulge following a flank incision supports the shift towards laparoscopic nephrectomy, and should be incorporated into decision making regarding the optimal surgical approach. This may be particularly relevant in the choice between open partial nephrectomy and laparoscopic radical nephrectomy in a patient with a normal contralateral kidney.

Aged↗

PubMedDate not supplied

Presurgery experiences of prostate cancer patients and their spouses.

PURPOSE: In this article, the authors describe the experiences of men with prostate cancer and their spouses between diagnosis and surgery. DESCRIPTION: As part of a longitudinal qualitative study, semistructured interviews were held with 34 prostate cancer patients who were waiting for surgery. Separate interviews were held with their spouses. RESULTS: Six main components of experience were evident from the analysis of transcripts related to the presurgery period: 1) the news of a diagnosis of prostate cancer came initially as a shock for both partners, the impact of which lessened over time; 2) the new reality of illness necessitated readdressing the marital relationship, most often resulting in a sense of renewed connection and commitment; 3) the illness crisis precipitated a search for information to guide decisions about treatment; 4) there was a need for couples to decide who to inform about the cancer diagnosis and how much to say about it; 5) couples attempted to seek a semblance of normality in their lives, especially after treatment decisions had been made; and 6) despite attempts to minimize the potential impact of upcoming surgery, anxiety was typically experienced at least intermittently by one or both partners. CLINICAL IMPLICATIONS: Physicians, nurses, social workers, and other health professionals need to facilitate attempts by the patient to gather and synthesize information. Cancer specialists can play a positive role in reducing distress in couples, and, thus, the attention of the specialists to communication issues is critical. The strain of waiting for surgery must be considered when treatment recommendations are made; watchful waiting protocols require further study from a psychological perspective. Clinicians need to be alert to the balance between being positive and carrying on as normal, and acknowledging and dealing with the distress that arises.

Activities of Daily Living↗

PubMedDate not supplied

Early postsurgery experience of prostate cancer patients and spouses.

PURPOSE: The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery. DESCRIPTION OF STUDY: As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery. RESULTS: Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption. CLINICAL IMPLICATIONS: Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.

Activities of Daily Living↗

PubMedDate not supplied

Implementing a nursing program via live interactive video: lessons learned.

Flexibility in scheduling and sensitivity to meeting the educational needs of today's diverse student population is a must in nursing education. The authors present an overview of how a college of nursing implemented an entire generic BSN program via live interactive television for nursing students 45 miles from the main campus. The authors describe the experience of initiating the program, facilitating faculty and student adaptation to the challenges of live interactive video education, and a summary of the first five years.

Education, Distance↗

PubMedDate not supplied

Rise in prostate-specific antigen in men with untreated low-grade prostate cancer is slower during spring-summer.

To test the hypothesis that the rate of rise in prostate-specific antigen (PSA) is slower during the spring-summer than during the rest of the year, we used PSA data from a prospective single-arm cohort study of men who had been followed to characterize a watchful observation protocol with selective delayed intervention for clinically localized, low-to-intermediate grade prostate adenocarcinoma. The rate of PSA increase was calculated as the visit-to-visit slope of log (PSA) against time, from 1 calendar-quarter visit to the next. The nonparametric Friedman test confirmed differences in rate of PSA rise among the calendar quarters (P = 0.041). Post hoc analysis showed the rate of PSA increase during Q2 was significantly slower than in each one of the other calendar quarters (Q1 versus Q2, P = 0.025; Q3 versus Q2, P = 0.002; Q4 versus Q2, P = 0.013), with no differences among quarters Q1, Q3, and Q4. These results are consistent with the vitamin D hypothesis that the higher 25-hydroxyvitamin D levels associated with spring and summer have a desirable effect on prostate biology. The therapeutic implication is that vitamin D supplementation in the range of 2000 IU/d, a dose comparable to the effect of summer, can benefit men monitored for rising PSA.

Adenocarcinoma↗