Tolerabilidad del paciente durante la cistoscopia y la cauterización de tumores vesicales en consulta: análisis multivariante de los factores de riesgo / Patient tolerability during office cystoscopy and bladder tumor cauterization: A multivariate analysis of risk factors

Objetivo La cistoscopia y la cauterización realizadas en el quirófano suponen un coste elevado y exponen a los pacientes a los riesgos asociados a la anestesia. La tolerabilidad de los pacientes durante la cistoscopia y la cauterización en la consulta es fundamental para el tratamiento ambulatorio del cáncer de vejiga y otras enfermedades urológicas. Se evaluaron los factores de riesgo asociados con el dolor percibido en la cistoscopia flexible en consulta, evaluando de manera independiente a un subgrupo de pacientes con cáncer de vejiga sometidos a cauterización. Materiales y métodos Análisis retrospectivo de 110 encuestas anónimas de pacientes completadas después de una cistoscopia y/o cauterización. La información de la encuesta incluía la edad, el sexo, la indicación de la cistoscopia, el número de cistoscopias previas, el número de cauterizaciones ambulatorias previas, la ansiedad antes/durante la cistoscopia y el dolor durante la cistoscopia y/o la cauterización. Se realizaron análisis univariantes/multivariantes y de regresión lineal para evaluar la asociación del dolor con los parámetros clínicos. Resultados El promedio del dolor percibido durante la cistoscopia (1,75±1,331) no difirió significativamente cuando se realizó también la cauterización (2,37±2,214) (p<0,001) (p=0,2840). Los pacientes del grupo de menor edad (<66 años) indicaron mayor ansiedad (p=0,0005), más dolor durante la cistoscopia (p=0,004) y la cauterización (p<0,001). Aunque el nivel de ansiedad general de los pacientes durante el procedimiento era bajo (1-3/10), se asoció con cierto nivel de dolor durante la cistoscopia (p=0,0005) y la cauterización (p<0,000). En el análisis multivariante, la ansiedad fue el único predictor independiente del dolor durante la cistoscopia (p=0,03; OR: 6,52; IC 95%:1,2-35,6) y la cauterización (p=0,0012; OR: 3,4; IC 95%:1,6-7,0)(AU)

Objective Cystoscopy and cauterization performed in the operating room is expensive and exposes patients to anesthesia risks. Patient tolerability during office cystoscopy and cauterization is critical to the office management of bladder cancer and other urologic diseases. We evaluated the risk factors for pain of flexible cystoscopy in the office-setting with emphasis on a sub-group of bladder cancer patients who underwent cauterization. Materials and methods Retrospective analyses of 110 anonymous patient surveys completed after cystoscopy and/or cauterization. Survey information included age, gender, purpose of cystoscopy, number of prior cystoscopies, prior number of office-cauterizations, anxiety prior/during cystoscopy, and pain during cystoscopy and/or cauterization. Univariate/multivariate and linear-regression analyses were performed to evaluate the association of pain with clinical parameters. Results Average pain during cystoscopy (1.75±1.331) was not significantly different when cauterization was also performed (2.37±2.214) (P<.001) (P=.2840). Patients in the lower age group (<66 years) indicated higher anxiety (P=.0005), more pain at cystoscopy (P=.004) and cauterization (P<.001). Although the patient's overall anxiety level was low (1–3/10), it was associated with some pain during cystoscopy (P=.0005) and cauterization (P<.000). In multivariate analysis, anxiety was the only independent predictor of pain during cystoscopy (P=.03, OR: 6.52, 95%CI: 1.2-35.6) and cauterization (P=.0012, OR: 3.4, 95%CI: 1.6-7.0) (AU)

Patient tolerability during office cystoscopy and bladder tumor cauterization: a multivariate analysis of risk factors.

OBJECTIVE: Cystoscopy and cauterization performed in the operating room is expensive and exposes patients to anesthesia risks. Patient tolerability during office cystoscopy and cauterization is critical to the office management of bladder cancer (BC) and other urologic diseases. We evaluated the risk factors for pain of flexible cystoscopy in the office-setting with emphasis on a sub-group of BC patients who underwent cauterization. MATERIALS AND METHODS: Retrospective analyses of 110 anonymous patient surveys completed after cystoscopy and/or cauterization. Survey information included age, gender, indication for cystoscopy, number of prior cystoscopies, number of prior office-based cauterizations, anxiety prior/during cystoscopy, and pain during cystoscopy and/or cauterization. Univariate/multivariate and linear-regression analyses were performed to evaluate the association of pain with clinical parameters. RESULTS: Average pain during cystoscopy (1.75 ±â€¯1.331) was not significantly different when cauterization was also performed (2.37 ±â€¯2.214) (p < 0.001) (p = 0.2840). Patients in the lower age group (<66 years) indicated higher anxiety levels (p = 0.0005), more pain at cystoscopy (P = 0.004) and cauterization (p < 0.001). Although the patients' overall anxiety level was low (1-3/10), it was associated with some pain during cystoscopy (p = 0.0005) and cauterization (p < 0.000). In multivariate analysis, anxiety was the only independent predictor of pain during cystoscopy (p = 0.03, OR: 6.52,95% CI: 1.2-35.6) and cauterization (p = 0.0012, OR: 3.4, 95%CI: 1.6-7.0). In BC patients, pain scores during cystoscopy and cauterization were not significantly different (p = 0.4772) but associated with anxiety. CONCLUSION: Office-based cystoscopy and cauterization are tolerable with minimal pain. Higher pain levels during cystoscopy were associated with procedure anxiety, and pain during cauterization was associated with procedure anxiety and younger age. Younger and more anxious patients may need more counseling before cystoscopy.

Effect of ginger & garlic on DNA content of gastric aspirate.

DNA content of gastric aspirates was studied before and after intragastric infusions of three doses of ginger (2, 4, 6 g) and four doses of garlic (0.3, 0.75, 1.5, 3 g) on different days in volunteers. Only one dose was administered on any day. The mean changes of DNA-p/min in gastric aspirates after intragastric infusions of 2 and 4 g ginger were -1.37 +/- 2.3 and 6.74 +/- 3.06 respectively, which were not significant statistically. However, 6 g ginger given intragastrically showed a mean significant increase in DNA-p/min of 3.23 +/- 1.02 (P less than 0.05). Intragastric infusion of 0.3 g uncooked garlic showed a non-significant increase in DNA-p/min of 0.307 +/- 0.59. On the other hand, infusion of 0.75, 1.5 and 3 g of uncooked garlic each caused significant increase in DNA-p/min of 5.47 +/- 1.63 (P less than 0.01), 10.42 +/- 3.46 (P less than 0.01) and 29.26 +/- 4.55 (P less than 0.001) respectively. Infusion of 3 g of cooked garlic also showed significant increase in DNA-p/min of 21.43 +/- 4.62 (P less than 0.001). There was no significant difference between the effect of cooked and uncooked (3 g) garlic. Ginger in quantities of 6 g or more and garlic in quantities of 0.75 g or more cause a significant increase in exfoliation of gastric surface epithelial cells in human subjects.

Eosinophilic granuloma of stomach.

A case of eosinophilic granuloma presenting as a large benign gastric ulcer is reported. On operation table, the lesion was interpreted as malignant.

Non-A, non-B hepatitis.

Diagnosis of non-A, non-B hepatitis (NANB) is made after exclusion of other known causes of hepatitis. Parenterally spread non-a, non-B hepatitis (PNANB) and enterally transmitted non-A, non-B hepatitis (ENANB) almost certainly appear to be two different diseases. The definite causative agents have not hitherto been identified. Much of our knowledge of NANB is based on (i) experimental studies on chimpanzees; and (ii) epidemiological studies. Parenterally spread non-A non-B hepatitis caused by whole blood transfusion and blood-product infusion has different incubation periods and may be caused by different agents. It is a mild disease clinically, and the majority of the patients are asymptomatic. It can be prevented only by judicious use of blood transfusion. Whenever possible, blood/blood products should be derived from individual volunteer donors who are anti-HBc sero-negative and have serum alanine transaminase of under 45 IU/l. Enterally-transmitted non-A non-B hepatitis is endemic in the Indian subcontinent, South-East Asia, North and East Africa and Latin America. Epidemic NANB is usually transmitted by water supply contaminated with feces. ENANB has a predilection for young adults. The disease is usually mild, except in pregnant women, who have a high case-fatality rate from fulminant hepatic failure. Control measures include provision of clean water supplies, safe disposal of human excreta and sound personal and food hygiene practices.

Adjuvant chemotherapy of head and neck cancer: the past, the present, and the future.

In the past two decades, overall survival of head and neck cancer patients has not improved significantly, despite improvements in surgery and radiotherapy techniques. In the early stages, head and neck cancer can be cured with surgery and/or radiotherapy. However, in patients who present with locally advanced lesions after combined surgery and radiation treatment, local recurrences develop in 50% to 60%, distant metastases in 20% to 30%, and a second primary neoplasm in 10% to 40%. Five-year survival for patients with stages III or IV disease who undergo standard treatment ranges from 0 to 60%. Traditional chemotherapy has been used for those patients with recurrent disease after surgery and/or radiotherapy, but the results have been disappointing. Therefore, chemotherapy as an induction regimen has been incorporated into combined modality treatment. The following specific issues of adjuvant chemotherapy will be addressed: (1) rationale for theoretic advantages of induction chemotherapy in head and neck cancer; (2) critical review of controlled and uncontrolled studies of adjuvant chemotherapy; (3) sequential chemotherapy and radiotherapy; (4) simultaneous chemotherapy and radiotherapy in head and neck cancer; (5) issues of surgical and radiotherapy complications following induction chemotherapy; (6) ongoing clinical trials of chemotherapy in head and neck cancer in the United States; (7) development of effective induction regimens in head and neck cancer; (8) future directions of adjuvant chemotherapy in head and neck cancer.

Prospective randomized trial of high-dose cisplatin and fluorouracil infusion with or without sodium diethyldithiocarbamate in recurrent and/or metastatic squamous cell carcinoma of the head and neck.

Previous studies have indicated that sodium diethyldithiocarbamate (DDTC) can reduce cisplatin's (CP) toxic effects without altering the antitumor activity. DDTC has also been shown to have immunostimulative properties. Sixty patients with objectively measurable recurrent and/or metastatic squamous cell carcinoma (SCC) of the head and neck were randomized to receive either (A) CP at 120 mg/m2 over one hour on day 1, plus fluorouracil (5-FU) at 1,000 mg/m2 over 24 hours as a continuous infusion on days 1 through 5, or (B) CP/5-FU as in A, plus DDTC at 600 mg/m2 over 30 minutes administered intravenously (IV) exactly 30 minutes after CP infusion. Group B also received DDTC at 200 mg/m2 administered IV over 30 minutes on days 8 and 15. Each cycle was repeated at 3-week intervals. Objective responses were achieved in 41% of the CP/5-FU group and in 29% of the CP/5-FU with DDTC group (P = .26). Median survival was 9 months in group A and 10 months in group B. CP-related toxicity between the groups was equivalent with respect to nausea and vomiting, renal impairment, neurotoxicity, ototoxicity, and hematologic toxicity. The pharmacokinetics of reactive platinum species in plasma ultrafiltrate and urine samples obtained from both groups were comparable. The immune status of 48 patients was evaluated before and after completion of therapy. There were no significant differences in mean pretreatment and posttreatment values within or between groups A or B, except for absolute pretreatment OKT4 values (P = .02). We conclude that (1) the present dose and infusion schedule of DDTC did not significantly reduce CP-mediated toxic effects, (2) DDTC did not alter the disposition of ultrafilterable platinum species, (3) DDTC did not affect immune responses, and (4) the addition of DDTC improved neither the clinical response nor the survival of patients with recurrent SCC of the head and neck.