Intraoperative asystole associated with fibroid uterus.

The authors present the case of a patient with a large retroperitoneal fibroid whose laparotomy was abandoned due to intraoperative asystole. Perioperative management and possible etiological factors are discussed in this paper.

Identifying the factors that influence energy deficit in the adult intensive care unit: a mixed linear model analysis.

BACKGROUND: Critically ill patients frequently receive inadequate nutrition support as a result of under- or overfeeding. Malnutrition in intensive care unit (ICU) patients is associated with increased morbidity and mortality. The present study aimed to identify the significant factors that influence energy deficit in the ICU. METHODS: ICU patients with a length of stay of ≥3 days were studied for 30 days over two consecutive years at a large university teaching hospital. Fifty-six Patients were studied, with a total of 530 records of feeding days. Information was collected for: day when feed initiated, age, gender, length of stay, Acute Physiological and Chronic Health Evaluation score (APACHE II), fed within 24 h, speciality, type of ventilation, feeding route, outcome (survived/died), diarrhoea (yes/no), aspirate volume, dietitian observed nutritional status (malnourished/not), sedation, estimated energy requirements and energy received. Mixed linear models for longitudinal data were used with energy deficit (energy received - energy requirements) as the dependent variable. RESULTS: Factors that were found to have a significant association with energy deficit were: day feeding was initiated (P<0.001), whether fed within 24 h (P<0.001) and whether sedated (P<0.001). Furthermore, three combined effects were found: ventilation mode and aspirate volume (P<0.007), fed within 24 h and ventilation mode (P<0.001), fed within 24 h and sedation (P<0.017). CONCLUSIONS: The number of days after feeding was initiated, initiation of feeding within 24 h and sedation have been identified as factors that predict energy deficit during ICU stay. Efforts to initiate feeding as soon as possible and minimise interruptions to feeding may reduce energy deficits in these vulnerable patients.

Examining stress: an investigation of stress, mood and exercise in medical students.

OBJECTIVES: Stress is an event that threatens homoeostasis and thus causes physiological and behavioural responses to reinstate equilibrium. Excessive and/or chronic stress can be psychologically and physiologically detrimental. Examinations can represent a significant source of stress for students. The hypothalamic-pituitary-adrenal axis (HPA) is the core endocrine stress system. Investigations into the HPA response to examinations have yielded inconsistent results. The aim of this study is to further explore the relationship between examination stress, HPA axis activity, mood, sleep and exercise in students undergoing a naturalistic examination period stressor. METHODS: In total, 16 medical students participated. Students completed self-reported stress, anxiety, mood, sleep and physical activity questionnaires, and provided saliva samples during an examination-free period and an examination period 1 month later. The cortisol awakening response, representative of HPA activity, was determined from saliva samples by enzyme-linked immunosorbent assay. RESULTS: Anxiety levels increased (p=0.04) and mood decreased (p=0.05) during the examination period. There was concomitant decease in physical activity levels (p=0.02). There was no significant increase in HPA activity during the examination period (p=0.29). Sleep quality did not significantly worsen (p=0.55) during the examination period. CONCLUSIONS: Examination periods are associated with increased anxiety levels, lower mood and decreased physical activity. Future studies incorporating examination results and cognitive function may help to identify potential protective interventional strategies, while optimising performance.

Epodyl in management of noninvasive vesical neoplasms.

A prospective study to assess the effects of triethylene glycol diglyceridyl ether (Epodyl) in the management of superficial noninvasive vesical neoplasm (T1) is presented. Apart from a few local side effects, the response of the tumor to Epodyl was very good as assessed up to three years. Further long-term studies are being done.

Tuberculous stricture of ureter.

Tuberculous stricture of the ureter is not uncommon in centers which treat large numbers of patients with urinary tuberculosis. Ninety-seven such strictures were seen in 92 patients over a twenty-five-year period. All patients were treated with appropriate antituberculous chemotherapy. Transurethral dilatation of the ureteral stricture was done on 80 ureters. Dilatation was successful in 51 ureters (64%) and failed to relieve the strictures in 29. Technical difficulties prevented dilatation of 17 ureters. We believe that transurethral dilatation should be attempted on all tuberculous ureteral strictures and that other procedures should be employed only if dilatation fails.

Primary nonfunctioning carcinoma of adrenal cortex.

Two cases of nonfunctioning adrenocortical carcinomas are presented. The clinical features, operative findings, and histopathologic appearances are discussed. It is believed that these tumors are difficult to diagnose because of their vague presentation. Intravenous urography with nephrotomography is the most valuable method of detecting these tumors, and surgery remains the best treatment.

Assessment of colorectal cancer knowledge and patient attitudes towards screening: is Ireland ready to embrace colon cancer screening?

INTRODUCTION: The level of awareness among the Irish public regarding colorectal cancer (CRC) remains uncertain. This study aimed to characterise CRC knowledge levels among a cohort of Irish patients. METHODS: A survey evaluating CRC knowledge levels was distributed among outpatients at a gastroenterology clinic in a Dublin teaching hospital. RESULTS: In total, 472 surveys were distributed of which 465 (98.5%) were returned. Twenty-nine percent of respondents correctly judged CRC to be the commonest cause of cancer death among the options provided while 26% correctly judged the lifetime risk of CRC; 59% underestimated and 15% overestimated the risk. Most patients (91%) were willing to pay 300 euros for a prompt colonoscopy if recommended by their physician while 7% opted to wait 6 months for a free colonoscopy. CONCLUSIONS: There is a willingness to embrace CRC screening and to shoulder some of the financial burden that this entails.

Hydrostatic overdistension for contracted tuberculous bladder. A review of 61 cases.

When a contracted tuberculous bladder is not improved on anti-tuberculosis drug treatment the bladder capacity can be increase by hydrostatic overdistension, done either cystoscopically if reflux is present, or by using a balloon catheter. Of 61 cases so treated, 40 showed marked improvement and 24 of these needed only one overdistension, and the rest required more than one treatment. Nine cases showed no improvement but no further deterioration and 12 cases had continued deterioration.

An assessment of surgical treatment of vesical outlet obstruction in spinal cord injury: a review of 471 cases.

An assessment of 139 cases of outlet obstruction following spinal cord injury, in a consecutive series of 471 patients, is presented. The figures in relation to the level and extent of the spinal lesion and the type of operation (transurethral resection and external sphincterotomy), are reviewed. The incidence of repeat operation is recorded and assessed. It is concluded that transurethral resection and external sphincterotomy, either alone or combined, will relieve outlet obstruction in most cases of neuropathic bladder following spinal cord injury.

The treatment of ureteric stones: report on 1120 patients.

A consecutive series of 1120 patients with ureteric stones is presented. Conservative and surgical treatment is discussed and the results of ureteric catheterisation, dilatation, transurethral manipulation and extraction, ureteric meatotomy and ureterolithotomy are presented.

Early and late management of the neuropathic bladder in spinal cord injury patients.

Early and late management of neuropathic bladders in 562 consecutive patients with spinal cord injuries is described. Indications for an operation to relieve outlet obstruction by transurethral resection and external sphincterotomy are outlined, and the management of urinary infection and incontinence is discussed. Approximately 30 per cent of all spinal cord injury patients had outlet obstruction for which either external sphincterotomy, transurethral resection or both procedures were necessary. Operations appeared to be required more frequently in patients with complete and thoracic lesions, and more than 1 operation may be necessary to achieve satisfactory bladder emptying.

Urological disability in quadriplegia: a study of treatment and follow-up in 92 patients.

The urological aspects of a series of 92 quadriplegic patients are presented. The types of operations done to relieve outlet obstruction and the long-term follow-up with particular emphasis upon the urographic findings and the incidence of pyelonephritis are described and discussed.

Reactivation of genito-urinary tuberculosis: a retrospective review of 838 cases.

Relapse occurred in 53 cases out of 838 consecutive cases of genito-urinary tuberculosis, followed for periods of 11 months to 27 years. Initial and recurrent disease is classified, and the treatment given is described. Length of inactivity is estimated, and correlated with the type of therapy given. Sensitivity of the organisms to chemotherapy is stated. Conclusions suggest that a life-long follow-up, at yearly intervals, of patients with genito-urinary tuberculosis is justified, as recurrences are diagnosed early, destructive changes are than unlikely, further surgery may be avoided, and a repeat course of chemotherapy is usually curative.

Transurethral removal of bladder stone: the place of litholapaxy.

The surgical management of 652 cases of bladder stone, with particular reference to the value of litholapaxy, is discussed. The majority of cases can be treated by closed methods--litholapaxy and transurethral removal. Those cases treated by closed methods have a reduced postoperative complication and morbidity rate, a shorter operating time, and a reduced period of hospitalisation. Provided the necessary skill is acquired, it is concluded that litholapaxy is a safe and efficient method of dealing with bladder stones.