Fear of going under general anesthesia: A cross-sectional study.

OBJECTIVES: Fears related to anesthesia have affected a considerable number of patients going for surgery. The purpose of this survey was to identify the most common concerns about general anesthesia during the preoperative anesthetic clinic in different healthcare settings, and whether they are affected by patients' sex, age, education, or previous experience of anesthesia or not. MATERIALS AND METHODS: Structured questionnaires with consent forms were distributed to patients in their preanesthesia clinic visit in three tertiary hospitals (King Abdul-Aziz Medical City, King Faisal Specialist Hospital, and King Khalid University Hospital) in Riyadh, Saudi Arabia. Patients' demographics and questions related to their fears regarding general anesthesia were included in the questionnaires. All categorical and interval variables were compared statically using a Chi-square test for independence and a t-test, respectively. All statistical tests were declared significant at α level of 0.05 or less. RESULTS: Among 450 questionnaires that were disturbed, 400 questionnaires were collected and analyzed. Eighty-eight percent experienced preoperative fear. The top three causes of their fears were fear of postoperative pain (77.3%), fear of intraoperative awareness (73.7%), and fear of being sleepy postoperatively (69.5%). Patients are less fearful of drains and needles in the operative theater (48%), of revealing personal issues under general anesthesia (55.2%), and of not waking up after surgery (56.4%). Age and gender were significant predictors of the overall fear among preanesthetic patients. Females are 5 times more likely to experience fear before surgery (P = 0.0009). Patients aged more than 40 years old are also at 75% higher risk of being afraid (P = 0.008). CONCLUSION: The majority of the patients going for surgery experienced a fear of anesthesia. Mostly females, especially those over 40, were at a higher risk of being afraid. Fear can bring anxiety which, in turn, might affect the patient's surgery.

Characterization of Mycobacterium tuberculosis of Lebanese patients by double-repetitive-element polymerase chain reaction.

Molecular studies have been successfully applied in evaluating epidemiological linkages in tuberculosis. A total of 87 isolates of Mycobacterium tuberculosis were collected from patients in all regions of Lebanon and characterized in terms of drug sensitivity. Double-repetitive-element polymerase chain reaction was used to differentiate between strains. Various correlations related to age, sex, region, sensitivity and genotype were examined. Several genotypes were more common in certain age ranges. Male patients appeared more likely either to be infected by or to develop multi-drug resistant strains. There was also evidence for a distribution of genotype groups indicating some level of geographical isolation and hence separate evolution of M. tuberculosis strains.

Depuration of highway runoff water into grass-covered embankments.

The management of polluted road runoff water is an important issue in environmental protection. A strategy could be to perform local depuration by infiltration into the soils of the embankment, but knowledge for designing such systems is lacking. This study aims at discussing the relevant soil properties, by estimating the long-term depuration of road runoff water infiltrating into the sandy soil embankment of the A9 highway in Wallis, Switzerland. This was done by estimating the heavy metals (HM) mass balance of two sites 23 and 12 years old, respectively. The accumulated HM were estimated by soil and GB analyses. The HM input was estimated by average water quality and traffic. The results were discussed using two-dimensional simulation of infiltration and a 14 months in situ monitoring of the runoff from the pavement to the embankment and at the bottom of the embankment. The soil properties were appropriate for both small particle adsorption and filtration. A good match between input and stored pollutant charges was found, and the HM profiles accorded well with infiltration simulation and monitoring results, which showed that 80-100% of the runoff water infiltrated into the embankment. Replacement of the cracked concrete gutters by an infiltration channel made of similar soil is recommended. These results oppose the Swiss guidelines for road-polluted water infiltration, as much more clayey soils are recommended. These later soils are difficult to find in Switzerland, and may allow for preferential flow through macro pores, in contrast to the studied site.

A 16-fold increase in organ donation in a Hispanic population.

UNLABELLED: Organ transplantation as a substitute for diseased organs in end-stage organ failure has led to a worldwide increase in this treatment modality, but donation has not kept pace with the demand, despite scientific, social, and government efforts. For many years, Hispanic donation in Puerto Rico was meager and lagged behind major centers in North America and Europe. Studies signaled mostly cultural factors in this limited donation. We report a 16-fold increase in organ donation with the development of a formal procurement organization tailored to a local culture. METHODS: The 30-year, 1400-transplant experience of the Puerto Rico Transplant Center was divided in three periods: 1977 through 1893, the latter signaling the approval of a transplant law; 1984 through 1995, signaling the commencement of a formal organ procurement organization; and 1996 through 2006. The subset of 2001 to 2006 was used in an additional calculation against 1984 to 1995. RESULTS: The comparison of the mean deceased donors from 1984 to 1995 with 1998 to 2006 shows a 12-fold increase; and the last 6 years versus 1984 to 1995, a 16.8-fold increase. CONCLUSION: Cultural and educational obstacles in a given country may be overridden by aggressive administrative and educational approaches and strategic planning tailored to local realities, with improvement in organ transplantation.

The fate of organs refused locally and transplanted elsewhere.

UNLABELLED: The number of kidney allografts procured from deceased donors has been fairly constant in the past few years, while organs from living donors steadily increase. In our program, existing protocols refused some kidneys which were subsequently accepted and transplanted at other hospitals. Thus, a review of our criteria to accept kidneys became necessary. METHODS: We studied the outcome of all kidneys refused by us but transplanted in other programs between 2002 and 2004. The data analyzed included ID no. donor, transplant center, procurement date, donor age, ischemic times, recipient alive or dead, creatinine level (when it was offered), initial function, hypertension, diabetes mellitus, biopsy, reason why the kidney was not accepted in our program, kidney functioning or lost, and cause of graft failure. The chi-square, Fisher, and t tests were used to analyze our data; P values of <.05 were regarded as significant. RESULTS: Originally 137, we excluded kidneys exported due to mandatory sharing (26 of 137 = 18.97%) and multiorgan placement (10 of 137 = 7.3%). Thus, 101 kidneys were not accepted by us because they did not meet the existing criteria of our program, but were accepted elsewhere. Reasons for nonacceptance were divided into donor quality, donor social history, donor age, donor size/weight, positive serological test, as well as organ preservation time, organ anatomical damage, elevated creatinine, abnormal urinalysis, abnormal biopsy, and decreased urine output. Donor issues were 66 of 101 (65.3%) with a graft loss of 13.6%, and organ issues were 35 of 101 (34.7%) with a graft loss of 66.6%. Donor quality totaled 24 of 66 (36.4%) and donor social history totaled 20 of 66 (30.3%); these were the most common causes for kidney nonacceptance related to donor issues. Reasons related to organ quality included elevated creatinine (15 of 35 = 42.9%; graft loss, 46.6%), and abnormal biopsy (9 of 35 = 25.7%; graft loss, 11.1%) and organ anatomical damage (4 of 35 = 11.4%; graft loss, 75%) (P = .42). Graft loss was more frequent with creatinine levels above 2.4 mg/dL (P < .001, RR gf = 1.5). Long-term fate of these 101 kidneys transplanted elsewhere: 82 (81.2%) were still working while 19 (18.8%) were lost. The causes of graft loss were renal artery thrombosis (42.1%), renal venous thrombosis (26.3%), death for other reasons (15.8%), graft never worked (10.5%), and ESRD (5.7%). The results suggest that the criteria for refusal related to donor issues, including hypertension, diabetes mellitus, donor age and donor size, should be revised owing to the low percentage of graft loss. Other donor issues such as positive serological test and donor social history (drug use, alcoholism) represent a serious potential risk for the health of recipients; for this reason, considering these persons as possible donors is very difficult irrespective of the graft outcome. Kidney refusals related to organ issues (especially elevated creatinine and anatomical damage) due to the very high percentage of graft loss should be considered high risk and probably be excluded. The increase in the demand of kidneys to be transplanted is a very important reason for a continuous and systematic review of donor exclusion criteria in every transplant program. The results presented here have helped us to improve both our outcomes and utilizations based on scientific evidence.

Nationwide study of drug resistance among acid-fast bacilli positive pulmonary tuberculosis cases in Lebanon.

OBJECTIVE: To assess the prevalence of drug resistance among smear-positive sputum specimens from pulmonary tuberculosis (TB) cases in Lebanon. DESIGN: Between July 2002 and April 2004, 224 newly diagnosed TB cases and 21 previously treated TB cases were collected nationwide. Mycobacterium tuberculosis isolates were tested against isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol (EMB) using the BACTEC-TB system. RESULTS: M. tuberculosis and non-tuberculous mycobacteria (NTM) isolates were recovered from 190 and 15 new cases, respectively, and from 16 and 1 previously treated cases, respectively. Overall drug resistance among new TB vs. previously treated TB cases was 19.5% and 75%, and for single drugs it was INH (12% vs. 63%), RMP (3% vs. 56%), SM (12% vs. 44%) and EMB (3% vs. 44%). The overall rate of multidrug resistance (MDR) was 5.8% (1% vs. 62.5%). The male:female ratio was 1.3:1; most were young adults. CONCLUSION: Relatively moderate single drug resistance and very low MDR rates were found among new TB cases, while among previously treated TB cases very high resistance and MDR resistance rates were detected. Such findings underline the need for ongoing stringent control measures to curb the spread of M. tuberculosis and its deleterious effects.

A marked increase in organ donation in Puerto Rico.

During its first years of existence, the Puerto Rico Transplant Program barely reached 18 to 20 renal transplants per year. A brain death amendment to the law improved the numbers but only to a stable thirty/year. Polls and studies showed that, although people knew about transplantation and expressed willingness to donate, the powerful emotional grief reaction, as well as a peculiar decision-making process, all militated against effective donation. In 1995, LifeLink of Puerto Rico was created as part of the very successful LifeLink Foundation of Tampa, staffed by local professionals. Cadaveric donation increased exponentially by 1227% and in 2004, 22.4 donors per million population were recovered, up from 1.5, one of the steepest growth curves in the United States. As a result, kidney transplantation increased, a cardiac transplant program was inaugurated, a pancreas transplant program has started, and liver will follow. The success is the result of well-trained, culturally sensitive coordinators and requestors; continuous education to the public, hospitals, administrators, neurospecialists, and critical care units; hospital development; implementation of federal law; and a sensitive approach the deceased donor family, and not only to the waiting list patients. The results demonstrate that organizational and educational factors can override cultural obstacles.

[Invasive infection by Aspergillus terreus treated successfully with liposomal amphotericin B]. / Infección invasiva por Aspergillus terreus tratada con éxito con anfotericina B liposomal.

A woman of 75 years old was admitted at our hospital for evaluation of worsening and weakness in inferior limbs. Several vertebral fractures by crushing, one doubtful discitis, an infiltrate with cavitation in the right superior lobe and one infiltrate in the left superior lobe were detected. In the biopsy of the consolidation a filamentous fungus was watched and in the bronchial washing specimen culture grew Aspergillus terreus. The infiltrates disappeared with liposomal Amphotericin B remaining with oral Itraconazol during three months more. The clinical and analytical data demonstrate the existence of a Overlap syndrome associate to antiphospholipid-antibody syndrome. We comment the peculiarity of the infection by Aspergillus terreus in patients who have not been in critical care and the good response at treatment with liposomal Amphotericin B. It contrasts with the high mortality referred in a recent review. Other aspects to comment are the coexistence with a collagen vascular and an antiphospholipid-antibody syndrome with the higher titles of IgM ACA that we have found in literature.

Mioblastoma de mama / Neoplasms muscle tissue of breast

Se presenta una especies portadora de un mioblastoma (tumor de células granulares) de la la mama, tumor poco frecuente y de importante diagnóstico diferencial con el cáncer de mama, debido a su gran semejanza clínica e imagenológica. Se trata de una paciente de 66 años de edad con nódulo de 3 centímetros de diámetro en mama derecha, de 6 meses de evolución, de consistencia pétrea, bien definido, no doloroso y con cambios en la piel subyacente, con estudio mamográfico: BI-rads 4. Se realiza biopsia incisional que reporto: Mioblastoma (Tumor de células granulares). En conclusión el mioblastoma representa un reto diagnóstico para el cirujano general debido debido a su semejanza con patología neoplásica. Se debe tener en cuenta al momento de la evaluación de pacientes con nódulos mamarios, en cuyo caso es de suma importancia el estudio anatomopatológico

Simultaneous detection of the three ilarviruses affecting stone fruit trees by nonisotopic molecular hybridization and multiplex reverse-transcription polymerase chain reaction.

ABSTRACT The three most economically damaging ilarviruses affecting stone fruit trees on a worldwide scale are the related Prunus necrotic ringspot virus (PNRSV), Prune dwarf virus (PDV), and Apple mosaic virus (ApMV). Nonisotopic molecular hybridization and multiplex reverse-transcription polymerase chain reaction (RT-PCR) methodologies were developed that could detect all these viruses simultaneously. The latter technique was advantageous because it was discriminatory. For RT-PCR, a degenerate antisense primer was designed which was used in conjunction with three virus-specific sense primers. The amplification efficiencies for the detection of the three viruses in the multiplex RT-PCR reaction were identical to those obtained in the single RT-PCR reactions for individual viruses. This cocktail of primers was able to amplify sequences from all of the PNRSV, ApMV, and PDV isolates tested in five Prunus spp. hosts (almond, apricot, cherry, peach, and plum) occurring naturally in single or multiple infections. For ApMV isolates, differences in the electrophoretic mobilities of the PCR products were observed. The nucleotide sequence of the amplified products of two representative ApMV isolates was determined, and comparative analysis revealed the existence of a 28-nucleotide deletion in the sequence of isolates showing the faster electrophoretic mobility. To our knowledge, this is the first report on the simultaneous detection of three plant viruses by multiplex RT-PCR in woody hosts. This multiplex RT-PCR could be a useful time and cost saving method for indexing these three ilarviruses, which damage stone fruit tree yields, and for the analysis of mother plants in certification programs.

Clinical remission of xeroderma pigmentosum-associated squamous cell carcinoma with isotretinoin and chemotherapy: case report.

We report the case of a 7-year old boy with xeroderma pigmentosum and a large squamous cell carcinoma of the cheek. He received a combination of isotretinoin (1 mg/kg/day) and chemotherapy for a period of 3 months and showed complete remission of the tumor. Treatment modalities of malignancies in xeroderma pigmentosum are reviewed and discussed in relation to the literature. The advantages of our protocol were emphasized because of the rapid improvement in a short time with minimal side effects.

[Cardiopathy and human immunodeficiency virus infection: report of 2 cases]. / Cardiopatía e infección por el virus de la inmunodeficiencia humana: presentación de dos casos.

Two patients with immune deficiency virus infection and cardiac manifestation are presented. The first was admitted by encephalopathy. On the first days of hospital stay were observed episodes of supraventricular tachycardia with echocardiography normal. An initial improvement made us suppose the clinical context in relationship to toxoplasmosis. Subsequently the patient experienced neurological deterioration and pericardial effusion was evidenced. Therapeutic trials with ceftriaxone and tuberculostatics were useless. The postmortem pericardial aspiration showed signs of acute inflammation, but germs were not identified. The second case was admitted for longstanding fever. Because of epigastric pain an electrocardiogram was done, which revealed suggestive alterations of pericarditis. The echocardiography demonstrated the presence of pericardial effusion. The positive serology for toxoplasmosis, the bone marrow biopsy which showed reactivity with hemophagocytosis and the presence of myeloid metaplasia in the liver biopsy were the most relevant data. On the fifth day of hospital stay and second of the tuberculostatic treatment the patient expired unexpectedly.

Outcome of young and elderly diabetic patients on ambulatory peritoneal dialysis: the experience of a community hospital in Puerto Rico.

OBJECTIVE: To analyze the clinical results of a group of young and elderly diabetic patients on ambulatory peritoneal dialysis at a large comprehensive tertiary care community hospital in San Juan, Puerto Rico in relation to rehabilitation characteristics, compliance, complications and survival. DESIGN: The medical records of all patients with a diagnosis of diabetes mellitus trained between June 1985 and June 1992 were reviewed. This group of patients was subdivided according to age, in young (20-50 years) and elderly (50 or over). A comparable number of nondiabetics were selected at random for each of the two age groups. MAIN OUTCOME MEASURES: The patient were studied for age, sex, need of assistance from a partner during dialysis, causes of transfer and hospitalizations, peritonitis, rehabilitation, patients compliance and outcome including mortality. RESULTS: Young diabetics versus non-diabetics: There were 45 patients in the diabetic group (37.8% females) and 57 in the non-diabetic group (54.4% female) with a total observation time of 52.52 patient-months among the diabetics and 82.17 patient-months in the non-diabetic. Mean age of the diabetic patient was 39.9 +/- 8.8 and 36.7 +/- 8.7 for the non-diabetic. Assistance by a partner during the dialysis procedure was needed by 26.7% of the diabetics and by 3.7% of the non-diabetics (p < 0.01). Of the non-diabetics, 91.2% were classified as compliant versus 75.6% of the diabetics (p < 0.05). Peritonitis was the main cause of hospitalizations and of transfers in both groups. The two years patient survival for the diabetic was 81.7% and 100% for the non-diabetic and the two years technique survival was 32.5% for the diabetic and 43.5% for the non-diabetic. Elderly diabetics versus non-diabetics: There were 76 patients in the diabetic group (36.8% female) and 64 in the nondiabetic (43.8% female). The mean age of the diabetic group was 61.3 +/- 6.2 years and 59.3 +/- 7.3 years for the non-diabetic with a total observation time of 81.86 patients-months for the diabetic and 104.58 patient-months for the non-diabetic. Assistance by a partner during dialysis was needed in 63.5% of the diabetics and 19.45% of the non-diabetics (p < 0.01). No statistical difference was found in the rehabilitation or compliance evaluation. Peritonitis stands out again as the main cause of transfer out of the PD modality and main cause of hospitalization in both groups. The two year patient survival for the diabetic was 51.5% and 73.3% for the non-diabetic, while the two years technique survival was 49% for the diabetic and 52.9% for the non-diabetic. CONCLUSIONS: A shortened technique survival, problems of compliance, a high peritonitis rate plus dependency on a partner for dialysis are features of the diabetic group. These findings demonstrate that the diagnosis of diabetes mellitus provides for the development of complications and barriers to the PD modality in both the young and the elderly.

Outcome of young and elderly diabetic patients on ambulatory peritoneal dialysis: the experience of a community hospital in Puerto Rico [see comments]

OBJECTIVE: To analyze the clinical results of a group of young and elderly diabetic patients on ambulatory peritoneal dialysis at a large comprehensive tertiary care community hospital in San Juan, Puerto Rico in relation to rehabilitation characteristics, compliance, complications and survival. DESIGN: The medical records of all patients with a diagnosis of diabetes mellitus trained between June 1985 and June 1992 were reviewed. This group of patients was subdivided according to age, in young (20-50 years) and elderly (50 or over). A comparable number of nondiabetics were selected at random for each of the two age groups. MAIN OUTCOME MEASURES: The patient were studied for age, sex, need of assistance from a partner during dialysis, causes of transfer and hospitalizations, peritonitis, rehabilitation, patients compliance and outcome including mortality. RESULTS: Young diabetics versus non-diabetics: There were 45 patients in the diabetic group (37.8 percent females) and 57 in the non-diabetic group (54.4percent female) with a total observation time of 52.52 patient-months among the diabetics and 82.17 patient-months in the non-diabetic. Mean age of the diabetic patient was 39.9 +/- 8.8 and 36.7 +/- 8.7 for the non-diabetic...

[Liver fibrosis associated with hepatorenal polycystosis in adults]. / Fibrosis hepática asociada a poliquistosis hepatorrenal del adulto.

OBJECTIVE: A case of hepatic fibrosis in adult polycystic liver disease is reported. This association, commonly present in infancy, is exceptional in the adult polycystic liver disease. PATIENT: We report a 69-years-old female with adult polycystic kidney and liver disease with fatal hepatic failure, portal hypertension and renal failure. An autopsy was performed showing hepatic and renal polycystic disease with hepatic fibrosis. CONCLUSION: Hepatic fibrosis is a rarely associated phenomenon with adult polycystic liver disease. This data may suggest a relation of this entity with infancy fibropolycystic liver disease.

Antinociceptive effect of morphine microinjections into the spinal trigeminal subnucleus oralis.

We analysed the effects of morphine microinjections (0.2 microliter) into the subnucleus oralis (SNO), i.e. the rostral division of the spinal trigeminal nucleus, on the formalin test adapted for orofacial pain. Duration of rubbing following an injection (50 microliters) of formalin solution (1.5%) in the right upper lip of the rat was measured. Compared to microinjections of saline (NaCl, 0.9%) used as control, 90 and 180 nmol microliter-1 of morphine solution in the SNO significantly curtailed rubbing. This effect was dose-dependent, reversed by naloxone, and also site-specific to the SNO since no effect was observed after microinjection of morphine into areas adjacent to the SNO. These results are further evidence for the involvement of the SNO in perioral nociceptive mechanisms.