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PubMed1995

Enteroviruses as a possible cause of myocarditis, pericarditis and dilated cardiomyopathy in Belém, Brazil.

We attempted to assess the role of enteroviruses in the etiology of myocarditis (MC), pericarditis (PC) and dilated cardiomyopathy (DCM) among 15 in-patients at a public hospital in Belém, Brazil, from November 1992 to December 1993. We obtained stool specimens and throat swabs from each patient (particularly acute cases) and, when possible, acute and convalescent serum samples for both isolation and serological procedures. MC, PC and DCM occurred in 10, 2 and 3 patients, respectively, mostly in the 0- to 10-year age group. Neutralizing antibody seroconversions were detected as follows: one for Coxsackievirus (Cox) B2 in one patient suffering from MC, and two for Cox B4, in patients with DCM and MC. In addition, antibody titers of 1/320 against Cox B2 and Cox B4 were noted in two other patients, one suffering from PC and the other presenting MC. Isolation of echovirus (ECHO) serotype 1 was recorded in a patient with MC, without either seroconversion or high antibody levels for Cox B 1 to 6. These results indicate that enteroviruses may be involved in the etiology of MC, PC and DCM in the Amazon region.

Adolescent↗
PubMed2006

The role of sexual satisfaction, age, and cardiac risk factors in the reduction of post-MI anxiety.

BACKGROUND: Anxiety is common after myocardial infarction (MI); however, little is known about the role of sexual satisfaction and return to sexual activity on anxiety post-MI. AIM: To examine the role of sexual satisfaction in reducing anxiety post-MI. METHODS: Patients with acute myocardial infarction (MI) recruited from one U.S. medical center completed questionnaires at baseline while hospitalized and at 1, 3, and 5 months post-MI. This analysis includes 64 patients compared on low or high anxiety at 5 months post-MI using sexual satisfaction and selected demographic and clinical variables in the analysis. RESULTS: Patients with high anxiety scores reported lower sexual satisfaction (p < .001) and a higher percentage of coronary risk factors (p < .01). The OLS regression model provided similar results with an adjusted R-square of .422, accounting for approximately 42% of anxiety (p < .001). Sexual satisfaction accounted for the most variance in the model, showing an inverse relationship between sexual satisfaction and anxiety. An inverse relationship also existed between age and anxiety. CONCLUSIONS: Anxiety is common after MI, and decreased sexual satisfaction appears to contribute to heightened anxiety. Attention to sexual concerns of MI patients before and after hospital discharge may improve psychosocial outcomes.

Age Factors↗
PubMedDate not supplied

The experiences and adjustments of women following their first acute myocardial infarction.

Very little is known about cardiovascular disease (CVD) in women and their specific needs throughout their recovery process. This study aimed to explore the experiences and adjustments of women following their first AMI. Naturalistic inquiry was used and six women were interviewed post their first AMI. Two major themes were identified: (1) 'the initial experience/event' which identifies events and emotions leading up to, and during, the hospital admission; and (2) 'support: for who and how' exploring the importance of support throughout the recovery process. The women in this study did not see themselves at risk of an AMI regardless of their lifestyles and when it did occur they adopted a variety of coping mechanisms in order to adjust to their trauma. The findings highlight the need for an increase in community awareness and education surrounding the risk factors of heart disease and its signs and symptoms, to minimize delayed hospital presentations.

Activities of Daily Living↗
PubMed1991

[Non-supervised home exercise programs in a convalescent phase of acute myocardial infarction: their effectiveness and the usefulness of the heart rate at the anaerobic threshold].

The effectiveness of 2 different exercise programs in the convalescent phase of acute myocardial infarction (AMI) was assessed. One hundred and five patients with AMI were enrolled for one of these 2 non-supervised home exercise programs immediately after discharge from the hospital. Before discharge and one month later, they underwent submaximal graded treadmill exercise tests with the application of expiratory gas analysis. All patients were assigned to perform 2 km of walk-jog exercise daily for one month. The heart rate during exercise, duration of exercise and the total steps during 24 hrs were measured. Eighty patients (group A) underwent the exercise program in which their heart rates were maintained at 100-110 beats/min during exercise; while 25 patients (group B) underwent the other program in which their heart rates were maintained at 90-100% of those obtained at their anaerobic threshold (AT). The ventilatory AT was calculated by the standard technique using the Horizon System. In group A, AT increased from 13.4 ml/min/kg to 15.1 ml/min/kg (p < 0.01) after the exercise program and in group B, from 12.8 ml/min/kg to 14.9 ml/min/kg (p < 0.01). In group B, AT increased in all patients, while it remained unchanged in 30% of the patients in group A (p < 0.01). In conclusion, a non-supervised home exercise program can be effective and easily instituted for rehabilitation in a convalescent phase of AMI. The program using 90-100% of the heart rates at the anaerobic threshold seemed to be more suitable for obtaining better effects on exercise tolerance than that using 100-110/min heart rate.

Aged↗
PubMed1985

Mental status and functional health 4 days following relocation to a nursing home.

Nurses frequently note changes in the health status of the aged following admission to a nursing home. The purpose of this study was to determine the stability of mental status and functional health over a 4-day period immediately following relocation from hospital to nursing home. Participants (N = 55) over the age of 60 were chosen sequentially as admitted to a 120-bed, long-term care facility for rehabilitation or convalescence, and interviewed on Day 1 and Day 4 following admission. Level of consciousness, attention/concentration, orientation, memory, and higher cognitive function were evaluated by the Mental Status Examination, and six activities of daily living were evaluated by the Scaled Outcome Criteria. A matched pairs t-test (p less than .05) demonstrated no significant differences in mean scores between Day 1 and Day 4. Results indicated that these short-term residents were stable in their mental status and functional health during the immediate period following relocation. Additional study is needed, with evaluation of the environment and its effect on participants' and expectation for length of stay.

Activities of Daily Living↗
PubMed1995

Laparoscopic versus open inguinal herniorrhaphy: preliminary results of a randomized controlled trial.

BACKGROUND: Benefits of laparoscopic herniorrhaphy (LH) over open hernia repair (OH) remain unproved. METHODS: Interim analysis of a prospective randomized controlled trial compared OH with LH where study outcomes were measured by third-party evaluators through patient interviews. RESULTS: Both groups were well matched for all baseline parameters, although LH patients anticipated a quicker postoperative recovery than OH (p = 0.014). No significant difference was noted in operating time or surgeon operative satisfaction. The median duration of hospital stay was 1 day in both groups; LH patients made use of significantly less postoperative narcotics than OH (p = 0.02). No difference was observed in the durations of convalescence (LH, 9.6 +/- 7.6 days; OH, 10.9 +/- 7.4 days). Greater improvements in quality of life were exhibited in LH patients than OH patients 1 month after operation (p = 0.035), with one of the two measures used. A greater percentage of LH patients seemed "very satisfied with their operation" (p = 0.07). Complication rates were similar, and a single recurrence, in a patient in the OH group, has been observed after a median follow-up of 14 months. CONCLUSIONS: Direct cost measurements showed LH to be 40% more expensive than OH in the context of a Canadian-type health care system. To date, benefits in postoperative pain and possibly quality of life have been detected in the LH group.

Adult↗
PubMed1988

Post-infectious disease syndrome.

Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis. Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research. This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years.

Fatigue↗
PubMedDate not supplied

Laparoscopic versus open preperitoneal prosthetic herniorrhaphy for recurrent inguinal hernia.

BACKGROUND: Laparoscopic herniorrhaphy (LH) shares the same repair principle as open preperitoneal prosthetic herniorrhaphy (PPH). Theoretically, the recurrence rate of LH for recurrent inguinal hernia will match the low recurrence rate of PPH (1.2-3%). METHODS: One-hundred forty-five cases of recurrent inguinal hernia were retrospectively studied between 1990 and 1994. Forty-two cases receiving LH were compared to 103 cases receiving PPH. RESULTS: There were no differences in operative time, hospital stay, morbidity rate, satisfaction scale and recurrence rate between the LH group and the PPH group. The LH group showed significantly less postoperative pain and 2 times shorter convalescence (p<0.01). Unsuspected asymptomatic contralateral hernia was found in 4.8% of patients receiving LH. 11.9% of patients had bilateral hernia repairing at the same time in the LH group. CONCLUSIONS: LH is suitable for recurrent inguinal hernia, but further investigation of this technique is required before its wide application.

Adult↗
PubMed2002

Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children.

OBJECTIVE: To compare surgical and device closure of isolated secundum atrial septal defect (ASD) in terms of hospital costs, clinical outcome, and impact on the patient and family. DESIGN: Prospective, observational study. SETTING: Paediatric tertiary referral centre. PATIENTS: Consecutive local children with a secundum ASD, admitted between 1 May 1999 and 1 May 2001. METHODS: Parents completed a standardised questionnaire at recruitment (on admission), at discharge, and one month after the procedure. Clinical and hospital generated cost data were collated at discharge. RESULTS: 62 children were included in the analysis: 19 who underwent surgical repair and 43 who underwent device closure with the Amplatzer septal occluder. Median procedure times and hospital stay were significantly longer for surgical patients (170 (147 to 180) v 92 (70 to 115) minutes and 88 (78 to 112) v 29 (28 to 30) hours, respectively; p < 0.01). There was no difference in the complication rate. No device patients required intensive care or blood products. The median values for postoperative pain score, analgesia use, and convalescence time were greater for surgical patients. The median cost of each procedure was similar, but higher nursing and laboratory costs contributed to a slightly greater total cost for surgical repair (Aus$12 969 ($11 569 to $14 215) v Aus$11 845 ($10 669 to $12 555), p = 0.03). CONCLUSIONS: Device closure of ASD involves a shorter hospital stay, causes less discomfort and familial disturbance, and carries less cost than surgical closure. However, there should be guarded acceptance of this technique until long term data are available.

Adolescent↗
PubMed1996

PCR Diagnosis of Malaria at Convalescent Stage Post-Treatment.

Malaria is one of the important febrile diseases that travelers contract after visiting tropical or subtropical countries. In Japan approximately 120 cases of imported malaria are reported annually, with additional cases remaining unreported. Because there are few hospitals where malaria-conscious doctors are readily available, some travelers are likely to resort to self-treatment before going to a clinic. We sometimes encounter such self-treated patients with negative blood smear for malaria parasites. It would be very informative if we could determine whether these self-treated patients had actually contracted malaria, using a more sensitive method than conventional microscopy.

Journal Article↗
PubMed1998

[Urologic laparoscopy in day hospital].

Thanks to the less invasiveness that is the limitation of the surgical trauma, the utilization of laparoscopic techniques for managing a wide range of urological disorders has vastly expanded over the past five years. The advantages of less postoperative pain, shorter convalescence and decreased analgesic use collide with the high costs and the necessity of a proper training. Few cases are reported in the literature about urological laparoscopic procedures performed on an outpatient basis. This is due to the requirement of the general anesthesia in most cases with prolonged operative and anesthesiological times. Urological laparoscopic procedures are applicable on an outpatient basis only if the length of the surgery is less than two hours and the patients are able to collaborate and without concurrent medical problems. Therefore we think that the urological laparoscopic diagnostic procedures feasible on an outpatient basis could be: pelvic lymphadenectomy, identification of intra-abdominal testis and intersex, renal biopsy. Varicocelectomy, intra-abdominal orchiectomy, renal cyst resection, pelvic lymphocelectomy and bladder neck suspension can be performed as same-day surgery. We emphasize that the appropriate patient selection is critical: the ability of the patient and his family to care for the patient at home following surgery is of paramount importance in the decision to proceed with outpatient surgery. The availability of appropriately trained and experienced doctors and nurses are crucial for the potential postoperative complications.

Ambulatory Surgical Procedures↗
PubMed1995

Treatment of nonendometriotic benign adnexal cysts: a randomized comparison of laparoscopy and laparotomy.

OBJECTIVE: To compare laparoscopy and laparotomy in the management of benign adnexal cysts, with particular attention to postoperative convalescence. METHODS: Forty premenopausal, nonpregnant women, 18-40 years of age and without acute pelvic symptoms, were scheduled to undergo surgical management of anechoic, unilateral, unilocular, persistent adnexal cysts from January 1993 through June 1994 at the Department of Obstetrics and Gynecology of the University of Cagliari, Cagliari, Italy. After ultrasonographic examination, followed by the completion of 6 months' expectant management with repeat ultrasonographic evaluations, subjects were randomized to undergo operative laparoscopy (n = 20) or laparotomy (n = 20). The patients were reviewed postoperatively at the out-patient clinic at 15, 30, 90, and 180 days. The intensity of pain was assessed by completion of a visual analogue scale on the results of the two groups were compared. We also compared the proportions of patients who were analgesic-free on day 2, discharged from hospital within 3 days, and feeling fully recuperated on day 15. RESULTS: The intensity of postoperative pain was significantly lower (P < .05) in the operative laparoscopy group than in the laparotomy group. A significantly higher (P < .05) proportion of the laparoscopy patients was analgesic-free on day 2, discharged from the hospital within 3 days, and feeling fully recuperated on postoperative day 15. CONCLUSION: After careful patient evaluation, management of anechoic, unilocular adnexal cysts by operative laparoscopy significantly reduces both the intensity of postoperative pain and the length of convalescence compared with laparotomy.

Adolescent↗
PubMed1995

Laparoscopic-assisted intestinal resection for Crohn's disease.

PURPOSE: The inflammatory process associated with Crohn's disease often makes dissection difficult, even in "open" surgery. This study was undertaken to determine if dissection and resection could be performed laparoscopically and whether it would benefit this group of patients. METHODS: Between November 1992 and November 1994, laparoscopic-assisted intestinal resection was attempted in 18 patients with Crohn's disease and was successfully completed in 14. One patient had ileal disease, requiring ileal resection with ileoileal anastomosis. The remainder had disease requiring ileocolic resections. Muscle-splitting incisions averaging 5 cm in length were made to facilitate removal of specimens. RESULTS: Commencement of oral alimentation was possible at an average of 3.6 (range, 1-7) days postoperatively. Discharge occurred at an average of 6.6 (range, 4-9) postoperative days. In comparison, 14 patients operated on by the authors for the same disease in the open manner during the past six months stayed an average of 8.5 (range, 5-14) postoperative days. Postoperative complications were minimal. CONCLUSIONS: On the basis of this initial study, it appears that laparoscopic-assisted intestinal resection can be readily performed in patients with Crohn's disease. In our early experience, we have found that laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complex fistulas, or recurrent Crohn's disease. Extraction incisions are frequently so large in these patients that they do not derive the same benefits from laparoscopic surgery that are enjoyed by patients without these findings. Most patients having laparoscopic resections eat earlier, may require fewer narcotics, and are able to be discharged from the hospital an average of two days earlier than patients operated on in an open manner. In addition, it appears that laparoscopic-assisted intestinal resection results in a shorter, easier convalescence and an earlier return to full activity.

Crohn Disease↗
PubMed1998

Role of Mycoplasma pneumoniae in acute respiratory-tract infections in Saudi paediatric patients.

The role of Mycoplasma pneumoniae and viruses in the various clinical presentations of acute respiratory-tract infection (ARTI) was studied in Saudi children seen at King Khalid University Hospital (KKUH) between January 1995 and January 1996. The study population comprised 511 children (age < 14 years) of both sexes. Nasopharyngeal aspirates (NPA) and acute-phase sera were collected. Convalescent sera were only available from 334 of the patients (with an interval of 15-42 days between collection of the acute and corresponding convalescent sera). Respiratory syncytial virus (RSV) was the most commonly detected virus, found in 69% of patients. Mycoplasma pneumoniae, found in 9% of the patients, appeared to be the second most common causative agent (this is the first time the prevalence of this agent in ARTI among Saudi children has been studied), followed by influenza A virus (present in 8% of the patients). RSV was highly prevalent during the colder months (October-April), with a peak in January-February, whereas there was little seasonal fluctuation in the prevalence of M. pneumoniae. Although most (60%) of the M. pneumoniae infections were in patients aged > 60 months, RSV was detected in 22% of the patients aged 1-5 months of age and only in 6% of those aged > 60 months. Infection with M. pneumoniae was found mainly in children with broncho-pneumonia (12 cases) and lobar pneumonia (three cases). Most of those infected with RSV had bronchiolitis (53 cases), followed by broncho-pneumonia (24 cases) and bronchial asthma (20 cases). As their prevalences were low, it was difficult to draw any conclusions about possible associations between the other viral agents encountered (influenza, para-influenza and adenovirus) and clinical disease.

Adolescent↗
PubMed2004

Neutralizing antibodies and Sin Nombre virus RNA after recovery from hantavirus cardiopulmonary syndrome.

Patients who later have a mild course of hantavirus cardiopulmonary syndrome (HCPS) are more likely to exhibit a high titer of neutralizing antibodies against Sin Nombre virus (SNV), the etiologic agent of HCPS, at the time of hospital admission. Because administering plasma from patients who have recovered from HCPS to those in the early stages of disease may be an advantageous form of passive immunotherapy, we examined the neutralizing antibody titers of 21 patients who had recovered from SNV infection. Even 1,000 days after admission to the hospital, 6 of 10 patients had titers of 800 or higher, with one sample retaining a titer of 3,200 after more than 1,400 days. None of the convalescent-phase serum samples contained detectable viral RNA. These results confirm that patients retain high titers of neutralizing antibodies long after recovery from SNV infection.

Adolescent↗
PubMed1992

[Return to work after myocardial infarction: evaluation and decision].

Working capacity after myocardial infarction depends on the physical and cardiovascular status, psychological repercussions and conditions of work. The latter two are much more important than the first two factors. Cardiovascular functional status is readily assessed by the large number of available investigations which leave little unknown. Exercise stress testing during the second week is the most cost-efficient investigation, providing reliable and sufficiently quantifiable data about the possible sequellae of cardiac failure on effort, ischemia and arrhythmias: an idea of the patient's functional capacity and circulatory responses (athletic, hyperkinetic) may also be obtained allowing adjustment of treatment to improve exercise capacity which goes much further than the statistical hope of prolonging survival. However, it would be naive to think that a satisfactory exercise stress test guarantees the patients' capacity to return to work. Psychological and sociological factors are more important by far. The dominant trait of the post-infarction psychological syndrome must be identified (anxiety, depression, negation): the positive and negative influences of the family, social and professional environment must be evaluated. A good knowledge of the patient's working conditions is essential to go against a number of taboos hindering the return to work (stress, stairs, restaurant meals, etc...). Finally, the medico-legal relationship between the infarct and work should not be neglected: the management of myocardial infarction when an occupational disease must respect the legislative and judicial texts which do not always correspond with everyday clinical practice. There is a lack of structures for cardiac function testing for assessing physical aptitude: we suggest that in the context of the proposed hospital reforms, departmental heads should consider setting up such units which would have a specific task respecting the spirit of these reforms. Nevertheless, cardiologists should pay more attention to the convalescent phase of infarction. This is the time when many social catastrophes can be avoided.

Arrhythmias, Cardiac↗
PubMed1996

An economic evaluation of peripheral blood stem cell transplantation as an alternative to autologous bone marrow transplantation in multiple myeloma.

Autologous peripheral blood stem cell transplantation (PBSCT) is increasingly being utilised as an alternative to autologous bone marrow transplantation (ABMT) in the treatment of malignant diseases. We have performed a pharmacoeconomic study using cost-minimisation analysis to evaluate the two techniques in a population of multiple myeloma patients undergoing PBSCT (n = 37) or ABMT (n = 14). In the PBSCT group, the time to > 0.5 x 10(9)/l neutrophils was significantly shorter (16 vs 22 days; P = 0.0019) as was the time to > 50 x 10(9)/l platelets (19 vs 27 days; P = 0.0019). The faster haematopoietic recovery resulted in a reduced period of intravenous antibiotic therapy (12 vs 19 days; P < 0.0001), reduced requirements for platelet transfusions (12 vs 31.5 units; P = 0.0005), and ultimately, a significant reduction in duration of hospitalisation (19 vs 27.5 days; P < 0.0001). These clinical benefits translated into economic benefits such that the total cost in the PBSCT group was 27.5% less than in the ABMT group (< Pounds 7995 vs < Pounds 11026; P = 0.0001). We conclude that the use of PBSCT as an alternative to ABMT in patients with multiple myeloma is associated with demonstrable economic advantages in addition to clinical benefits.

Adult↗