Application of a topical vapocoolant spray decreases pain at the site of initial intradermal anaesthetic injection during ultrasound-guided breast needle biopsy.

AIM: To assess whether the application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy decreases pain at the site of the initial injection. MATERIALS AND METHODS: In this institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study, 50 women aged 49.1 ± 1.6 years (mean ± standard error) were recruited and provided written informed consent. Participants served as their own controls and were blinded as to whether a topical vapocoolant spray or a placebo was used immediately prior to the initial local anaesthetic injection at two separate biopsy sites. With the exception of the application of vapocoolant or placebo, the entire ultrasound-guided procedure was performed according to a routine protocol. Participants recorded pain at initial injection site on a visual analogue scale. General linear mixed models for repeated measures analysis of variance and a 0.05 significance level were used. RESULTS: Application of topical vapocoolant spray was shown to significantly decrease pain at the site of initial intradermal anaesthetic injection as compared to placebo (p<0.001). Treatment effect was independent of age of the subject, race/ethnicity, operator, type of biopsy device, and histopathology result. No complications from vapocoolant spray use were reported. CONCLUSION: Application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy significantly decreases pain at the site of the initial injection and could contribute to improve the patient's overall procedural experience.

[Prevalence of Parkinson disease in an urban area of the Ciudad de La Habana province, Cuba. Door-to-door population study]. / Prevalencia de la enfermedad de Parkinson en un área urbana de la provincia Ciudad de La Habana, Cuba. Estudio poblacional "puerta a puerta".

OBJECTIVE: To determine the prevalence of Parkinson's disease in an urban area of Havana City province, Cuba. BACKGROUND: Parkinson's disease is one of the most frequent chronic neurodegenerative diseases in the elderly. Prevalence varies widely between different geographic areas and type of studies. To the author's knowledge, there are not epidemiological data on Parkinson's disease in Cuban population that allows a real estimation of the true magnitude of the disease. PATIENTS AND METHODS: A "door-to-door" population study was carried out between November and December 1997. The area total population aged 15 years and over (n = 17.784) was interviewed and examined during the first phase of the study. This phase was performed by the 33 family doctors practicing in that area. An experienced neurologist previously trained the family doctors on making Parkinson's disease diagnosis. Diagnosis was based on the Brain Bank Society criteria. In order to make a definitive diagnosis of Parkinson's disease every subject that received such a diagnosis during the first phase was re-evaluated by two experienced neurologists. Those subjects with final diagnosis of Parkinson's disease were asked about family history of the disease. Prevalence rates were calculated according to sex, age group, color of the skin and smoking status. RESULTS: A total of 24 subjects received the final diagnosis of Parkinson's disease, yielding a population prevalence rate of 135 x 100,000 inhabitants. Eight subjects (33.3%) received a diagnosis of Parkinson's disease for the first time (de novo cases). Subjects with white color of the skin and non-smoking subjects showed a statistically significant higher prevalence of Parkinson's disease than subjects with non-white color of the skin and non-smokers respectively. Only 3 (12.5%) subjects reported a family history of Parkinson's disease. CONCLUSION: The population of this area has a low prevalence rate of Parkinson's disease compared to that reported in other populations. The observed low frequency of family history of the disease suggests that the main determinants of Parkinson's disease are environmental factors yet to be identified.

Hepatitis B virus exposure in human immunodeficiency virus seropositive Cuban patients.

In order to estimate the prevalence of serological markers of exposure to Hepatitis B Virus (HBV), 295 subjects were selected at random from the National Registry of human immunodeficiency virus positive subjects. Evidence of exposure to HBV was defined as: testing Hepatitis B surface antigen (HBsAg) and anti-Hepatitis B core antigen (anti-HBc) positive or anti-HBc positive only. Overall, 133 (45.5%) were positive for anti-HBc and 15 (5.1%) resulted positive to HBsAg. Significant statistical association was found between male sex and exposure to HBV (p<0.01). Homosexual or bisexual behavior was found to be strongly associated to HBV exposure (p<0.001). In conclusion, the prevalence of HBV serological markers is higher in Cuban HIV positive subjects compared to the Cuban general population.

Prevalence and management of hypertension in type 1 diabetes mellitus in Europe: the EURODIAB IDDM Complications Study.

AIM: To examine the prevalence of hypertension and the rates of hypertension awareness by investigating treatment and control among respondents to the EURODIAB IDDM Complications Study, and to explore the variation in hypertension management by age, sex and end-organ damage. METHODS: A cross-sectional study, examining 3250 randomly selected Type 1 diabetic patients from 31 diabetes clinics in 16 European countries between 1989 and 1990. Mean age was 32.7 years (SD= 10.0) and mean duration of diabetes mellitus (DM) was 14.7 years (SD=9.3). Subjects were asked about a history of high blood pressure (BP) and current prescribed medications were recorded by the subject's physician. Hypertension was defined as having a systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or current use of antihypertensives. Control was defined as a BP < 130/85 mmHg. RESULTS: Twenty-four per cent of subjects had hypertension, among whom fewer than one-half (48.5%) were aware of a previous diagnosis and a similar proportion (42.2%) were on treatment. Only 11.3% of those with hypertension were both treated and controlled. The majority (81%) of those receiving drug therapy for hypertension were on a single drug, most commonly an angiotensin-converting enzyme inhibitor (47%). CONCLUSION: These data show the extent of undermanagement of hypertension in Type 1 DM across Europe prior to the publication of the St. Vincent Declaration and provide a useful baseline against which future improvements in the management of hypertension can be monitored.

Mortality of childhood-onset IDDM patients. A cohort study in Havana City Province, Cuba.

OBJECTIVE: To determine the survival pattern and the underlying cause of death in a cohort of childhood-onset IDDm subjects from Havana City Province, Cuba. RESEARCH DESIGN AND METHODS: This was a descriptive study carried out on a historical cohort of IDDM subjects with disease onset before 15 years of age in Havana City Province, Cuba. The cohort was assembled from several sources. Subjects were diagnosed from 1965 to 1980, and their vital status was assessed at 31 December 1991. Cumulative survival rate was calculated by the Kaplan-Meier method, and a univariate analysis was performed. To test survival differences between groups, the Cox-Mantel test was used. To compare the cohort mortality with the general population, standardized mortality ratios by sex and age were calculated. Specific causes of death were determined by a committee examining death certificates, clinical records, and necropsy reports. RESULTS: A total of 504 subjects were identified, and the mean follow-up time was 17.5 years. Of the subjects, 70 (13.9%) had died at 31 December 1991. Overall, the cohort had a 71% cumulative survival rate at 25 years of IDDM duration. There were no survival differences according to sex or calendar period of IDDM diagnosis. Statistically significant differences were found among age-at-diagnosis groups. The group with a peripubertal age at diagnosis showed the worst prognosis. The cohort experienced 8.5 times the all-causes death rate, compared with the general population. Renal disease accounted for almost half the deaths. CONCLUSIONS: IDDM subjects from Havana City Province, Cuba, showed a better survival pattern than IDDM subjects from other developing countries. However, when compared with IDDM populations from developed countries, there is a survival reserve to be achieved by reducing mortality due to renal disease and infections.