RESUMO
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.
Assuntos
Afeto , Exercício Físico , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipófise-Suprarrenal/metabolismo , Estresse Psicológico/metabolismo , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Hidrocortisona , Masculino , Estresse Psicológico/psicologia , Adulto JovemRESUMO
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.
Assuntos
Parada Cardíaca/etiologia , Complicações Intraoperatórias/etiologia , Laparotomia/efeitos adversos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Cuidados Críticos/métodos , Metabolismo Energético/fisiologia , Unidades de Terapia Intensiva , Apoio Nutricional/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ingestão de Energia , Feminino , Humanos , Tempo de Internação , Modelos Lineares , Masculino , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Necessidades Nutricionais , Estado Nutricional , Estudos Prospectivos , Fatores de TempoRESUMO
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.
Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento , Satisfação do Paciente , Adulto , Conscientização , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
1. Dab, Limanda limanda, exposed to nominal concentrations of 0 (control), 0.0032% (low) and 0.032% (high) sewage sludge in seawater for 12 weeks, were assessed for their immunological competence. 2. No effect upon total blood leucocyte and erythrocyte numbers was found, although significantly fewer thrombocytes were seen in the high-exposure group. 3. A decreased serum protein level was found in the high exposure group, but lysozyme and immunoglobulin levels showed non-significant differences between the groups. 4. Melano-macrophage centres were also affected in the high-exposure dab, which had increased numbers in the spleen and kidney. No effect upon spleen weights or oxygen free radical production by splenocytes was noted. However, oxygen free radical production by kidney leucocytes was inhibited in the low-exposure dab.
Assuntos
Peixes/imunologia , Imunocompetência/efeitos dos fármacos , Esgotos/efeitos adversos , Poluentes Químicos da Água/toxicidade , Animais , Rim/efeitos dos fármacos , Rim/patologia , Fagócitos/efeitos dos fármacos , Baço/efeitos dos fármacos , Baço/patologiaRESUMO
We treated 414 new patients with stage pTa, grades 1 and 2 bladder tumors by transurethral resection between 1970 and 1982. All of the patients with grade 3 or previous upper tract tumors, or who had been treated at some stage with intravesical chemotherapy were excluded. Followup for 5 or more years was available in 188 of the patients. There was a low increase in T stage (6 per cent). Of the patients followed for 5 or more years 46 per cent remained free of tumor. Only 16 per cent of the patients had multiple tumors at presentation and 20 per cent had tumors of 10 gm. or more. These factors were associated with a worse prognosis. Patients free of tumor at 3 months had an 80 per cent chance of having no further recurrences and this rate remained the same up to 2 years from the start of the disease. Patients with a recurrence at 3 months were much less likely to remain free of tumor, and had a higher chance of recurrence at every future visit.
Assuntos
Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias da Bexiga Urinária/cirurgia , Seguimentos , Humanos , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologiaRESUMO
In an 11-year period, 49 patients developed bladder neck contracture after prostatectomy--an incidence of 0.86%. This complication was found to be more common after resection of small fibrous hyperplastic prostates. The best results for treatment of the contracture were obtained after bladder neck incision, which gave a 9% incidence of recurrence; after transurethral resection of the bladder neck contracture the recurrence rate was 46%, and after bladder neck dilatation it rose to 100%.
Assuntos
Prostatectomia/efeitos adversos , Obstrução do Colo da Bexiga Urinária/etiologia , Idoso , Dilatação , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Bexiga Urinária/cirurgia , Obstrução do Colo da Bexiga Urinária/terapiaRESUMO
A follow-up of 406 traumatic spinal cord injuries admitted from 1967 to 1982 is presented. Forty patients died, only two (5% of deaths and 0.5% of the series) from renal complications. Twenty-seven died from pulmonary or cardiovascular causes, complete and cervical lesions being the most significant factors in mortality. Early and continued active urological treatment aimed at the provision of low pressure bladder drainage to protect the upper tract. The management and results are critically discussed.
Assuntos
Traumatismos da Medula Espinal/complicações , Doenças Urológicas/etiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/mortalidade , Transtornos Urinários/etiologia , Transtornos Urinários/terapia , Doenças Urológicas/cirurgiaRESUMO
Ureterovaginal fistula is an uncommon complication of pelvic operations, seen most often after Wertheim's hysterectomy. We report 12 cases of ureterovaginal fistulas seen during a 20-year period, all of which followed operations for benign gynecologic conditions. Most patients had no urinary symptoms until the sudden onset of incontinence 1 to 4 weeks postoperatively. Diagnosis was established readily by a combination of excretory urography, cystography, cystoscopy, retrograde pyeloureterography and dye studies. In our series only 1 patient was treated by primary nephrectomy, while 11 underwent ureteroneocystostomy: 2 with a Boari flap and 9 by a direct method. Reconstruction failed in 2 patients, 1 of whom required a secondary nephrectomy.
Assuntos
Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Fístula Vaginal/etiologia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgiaRESUMO
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.
Assuntos
Tuberculose Renal/complicações , Obstrução Ureteral/etiologia , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Criança , Dilatação/métodos , Endoscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Tuberculose Renal/tratamento farmacológico , Ureter/cirurgia , Obstrução Ureteral/terapia , Bexiga Urinária/cirurgia , Cateterismo Urinário/métodosRESUMO
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.
Assuntos
Cálculos Ureterais/cirurgia , Dilatação , Humanos , Métodos , Ureter/cirurgia , Cateterismo UrinárioRESUMO
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.
Assuntos
Quadriplegia/complicações , Doenças Urológicas/etiologia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Cateterismo Urinário , Derivação Urinária , Doenças Urológicas/cirurgiaRESUMO
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.
Assuntos
Córtex Suprarrenal , Neoplasias das Glândulas Suprarrenais/diagnóstico , Carcinoma/diagnóstico , Córtex Suprarrenal/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Carcinoma/cirurgia , Feminino , Humanos , MasculinoRESUMO
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.
Assuntos
Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/cirurgia , Seguimentos , Humanos , Fatores de Tempo , Bexiga Urinaria Neurogênica/etiologia , Incontinência Urinária/etiologia , Infecções Urinárias/etiologiaRESUMO
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.
Assuntos
Éteres/uso terapêutico , Etoglucida/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Diatermia , Etoglucida/administração & dosagem , Etoglucida/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária/terapiaRESUMO
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.
Assuntos
Cálculos da Bexiga Urinária/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Uretra , Cálculos da Bexiga Urinária/mortalidadeRESUMO
A series of 76 cases of closed renal trauma is presented. The clinical and radiological features are described and the indications for conservative and surgical treatment discussed.