Anesthesia for major urologic surgery.

This article details the anesthetic management of robot-assisted and laparoscopic urologic surgery. It includes the key concerns for anesthetists and a guide template for those learning this specialist area. The emphasis is on the principles of enhanced recovery, the preoperative and risk assessments, as well as the specific management plans to reduce the incidence of complications arising as a result of the prolonged pneumoperitoneum and steep head-down positions necessary for most of these procedures.

Limited usefulness of antithyroperoxidase and antithyroglobulin assays in Jamaicans with Graves' disease.

The clinical usefulness of commercially prepared haemagglutination kits for thyroperoxidase (TPO) antibody and thyroglobulin (TG) antibody was evaluated in 145 consecutive Jamaicans with Graves' disease. Sixty two (43%) of the patients were newly diagnosed, 12 (8%) were in remission and 71 (49%) had relapsed. Sera from 65 (45%) patients were positive for thyroid antibodies. The TPO antibodies were found in 43% (63/145), thyroglobulin antibodies in 12% (17/145) fifteen (10%) patients had both anti-TPO and TG antibodies. Similar prevalences of TPO antibody were found in newly diagnosed patients and those who had relapsed (44% v. 41%) but the prevalence in the patients in remission was significantly higher (75%; X2 = 4.8, P < 0.05). The prevalence of TPO antibody increased significantly with age at onset before age 35 years compared to later onset (56% v. 32%; X2 = 8.09, P < 0.005). The presence of both TPO antibody (64% v. 31%; X2 = 13.1, P < 0.001) and TG antibody (22% v. 6%; X2 = 8.8, P < 0.005) correlated positively with Graves' ophthalmopathy. Neither of the tests was adequately sensitive in detecting GD in Jamaicans but we recommend testing for TPO antibody without TG antibody as a cost-effective approach. The presence and titres of TPO antibody and TG antibody do not correlate with disease activity and are not reliable enough for monitoring antithyroid drug therapy in GD. There is a need for antibody tests which are efficacious in diagnosing and monitoring antithyroid drug therapy in GD, and suitable for use in developing countries.

Systemic lupus erythematosus, rheumatoid arthritis and HLA phenotypes in Jamaicans.

The HLA phenotypes were investigated in 30 Jamaican patients with Systemic Lupus Erythematosus (SLE), 30 with Rheumatoid Arthritis (RA) and 40 healthy controls. HLA phenotypes were determined by the microcytoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statistically significant. However, a statistically significant lack of HLA-A9 (p < 0.01; CP < 0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant association was noted with HLA-A2 (RR 5.1; CP < 0.01). No HLA class II associations were noted with SLE. Class II associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted.

Seroprevalence of autoantibodies in selected and unselected populations in Jamaica.

Various serological techniques were used to investigate the prevalence and distribution of autoantibodies in healthy Jamaicans and patients with autoimmune and non-autoimmune disease. Low concentrations of autoantibodies were found in healthy Jamaicans, including thyroid (1.5%), gastric parietal cell (1.4%) and smooth muscle (11.3%). There was no significant age or sex predominance in the distribution of autoantibodies in the healthy population though autoimmune disease was more prevalent in females. Serological overlaps occurred but the comparative distributions and concentrations of autoantibodies in patients with autoimmune disease and non-autoimmune disease, and healthy subjects indicate that currently available methods of autoantibody determination may be used successfully in diagnosis in Jamaica. Failure to detect circulating pancreatic islet cell antibodies in insulin-dependent diabetic patients as well as in healthy Jamaicans questions the pathogenicity of these antibodies and diminishes their diagnostic usefulness in this population.

Biological false positive serological tests for syphilis in the Jamaican population.

A total of 19,067 sera were screened for biological false positive (BFP) reactivity by the Venereal Disease Research Laboratory (VDRL) test. Sera which were reactive in the VDRL test were confirmed by the fluorescent treponemal antibody absorption (FTA-ABS) test. BFP reactions were detected in 0.59% of the general population, 0.72% of pregnant women and 11.8% of patients with systemic lupus erythematosus (SLE). The rate of BFP reactors among pregnant women did not differ significantly from the general population. The female to male ratio of BFP in the general population was 2:1 whilst that in the group of patients with SLE was 8:1. The overall seroprevalence of syphilis was 2.2%.

PIP: The Venereal Disease Research Laboratory (VDRL) test for syphilis was used to screen 19,067 Jamaican sera, and positive were confirmed with the fluorescent Treponema pallidum haemagglutination assay (FTA-ABS). The group included 15,876 persons applying for emigration, 3039 pregnant women attending prenatal care, and 152 patients with systemic lupus erythematosus (SLE). 2.8% of the general population were VDRL positive, and of these 21.3% had titers 1:4. 4.7% of the pregnant women were positive, 48.2% with titers 1:4. 27.1% of the VDRL positive in the general population and 30.9% of the pregnant women were false positive, i.e.negative on the FTA-ABS test. 78.2% of the SLE patients were false positive on the VDRL, including 1 patient with a titer of 1:128. Thus the percentage of false positive taking the whole group as denominator was 0.59% in the general population, 0.72% in the pregnant women, but 11.8% among SLE patients. The overall seroprevalence of syphilis was 2.2%. These results are atypical in that pregnant women are usually considered to have a high rate of false positive results on the VDRL.

Diagnosis of neurosyphilis: a critical assessment of current methods.

Clinical features of 74 patients with neurosyphilis and 38 syphilitic patients with nonsyphilitic neurologic disorders were correlated with results of their serum and cerebrospinal fluid (CSF) VDRL and FTA tests, and with the WBC count and total protein level in the CSF. The most common clinical features in those having neurosyphilis were reflex changes (53.9%), peripheral neuropathy (44.5%), ataxia (38%), and cranial nerve palsies (24.3%). In 27% of the patients with neurosyphilis the CSF was VDRL-reactive, while in 77% the CSF was FTA-reactive. The frequency of elevated WBC counts in various serologic categories ranged from 23% to 46%, and the frequency of elevated protein levels ranged from 23% to 27%; neither the mean WBC count nor the protein level differed significantly among the different serologic categories (P less than .05). Only two of the 74 patients with neurosyphilis had elevation of both the WBC and protein level. None of the syphilitic patients without neurosyphilis had an elevated WBC or protein level, though the CSF was FTA-reactive in all 38. Among the neurosyphilis patients whose CSF was VDRL-nonreactive but FTA-reactive, 21% had an elevated protein level and 26% had an elevated WBC count. These results support the view that patients having neurosyphilis will not necessarily have either VDRL-reactive CSF or the other expected CSF abnormalities.

Diagnosis of systemic lupus erythematosus in Jamaica by Crithidia luciliae indirect immunofluorescence test.

The Crithidia luciliae indirect immunofluorescence test (CL-IFT) was compared with the DNA-binding assay for confirmation of the presence of double-stranded DNA (dsDNA) antibodies in cases of systemic lupus erythematosus (SLE). The study involved 142 patients whose sera had anti-nuclear antibodies (ANA). In 62 patients with clinical or suspected SLE, 66% gave positive CL-IFT results as against 69% by DNA-binding. Two patients who had negative CL-IFT results but positive DNA-binding were only marginally positive (31% and 36%). Anti-dsDNA antibody was not found in any ANA negative sera. C. luciliae is easily maintained in culture and the test is relatively easy to perform in any laboratory with facilities for doing fluorescence microscopy; we recommend it for confirmation of the diagnosis of SLE, especially in laboratories with limited resources.

Transmission of infectious drug resistance from animals to man.

The antibiotic resistance patterns of coliforms in faecal specimens from pigs and their human contacts were studied. The ability of the resistant coliforms to transfer their resistance in vitro to antibiotic-sensitive recipients was examined. The results showed that pigs which had received antibiotics carried more multiply-resistant, R-factor bearing coliforms than pigs which had not been given antibiotics. Human contacts of the antibiotic-treated pigs had a higher incidence of antibiotic-resistant coliforms with R-factors than human contacts of pigs which had not been given antibiotics. It is concluded that antibiotic treatment of farm animals may lead to acquisition of antibiotic resistance by gut coliforms of man.

Lunar anorthosite 15415: texture, mineralogy, and metamorphic history.

Lunar anorthosite 15415 consists almost entirely of anorthite (homogeneous anorthite 96.6 molecule percent), with accessory diopsidic augite and traces of hypersthene, ilmenite, and a silica mineral. The rock has had a complex metamorphic history. The texture reflects at least two episodes of shearing (followed by intense and partial recrystallization, respectively), one episode of cataclastic deformation, and one or more episodes of shattering and fragmentation.

Petrology of unshocked crystalline rocks and shock effects in lunar rocks and minerals.

On the basis of rock modes, textures, and mineralogy, unshocked crystalline rocks are classified into a dominant ilmenite-rich suite (subdivided into intersertal, ophitic, and hornfels types) and a subordinate feldspar-rich suite (subdivided into poikilitic and granular types). Weakly to moderately shocked rocks show high strain-rate deformation and solid-state transformation of minerals to glasses; intensely shocked rocks are converted to rock glasses. Data on an unknown calcium-bearing iron metasilicate are presented.

Shock and thermal metamorphism of basalt by nuclear explosion, nevada test site.

Olivine trachybasalt metamorphosed by nuclear explosion is classified into categories of progressive metamorphism: (i) Weak. Plagioclase is microfracruree, and augite contains twin lamellae. (ii) Moderate. Plagioclase is converted to glass, amd mafic minerals show intragranular deformation (undulatory extinction, twin lamellae, and, possibly, defomation lamellae), but rock texture is preserved. (iii) Moderately strong. Plagioclase glass shows small-scale flow, mafic minerals are fractured and show intragranular deformation, and rocks contain tension fractures. (iv) Strong. Plagioclase glass is vesicular, augite is minutely fractured, and olivine is coarsely fragmented, shows moscaic extinction, distinctive lamellar structures, and is locally recrystallized. (v) Intense. Rocks are converted to inhomogeneous basaltic glass.

Jadeite: shock-induced formation from oligoclase, ries crater, Germany.

Jadeite (high-pressure sodium aluminum pyroxene) has been identified in a shock-phase assemblage of oligoclase. The shock assemblage consists of minute particles with high refractive indices that contain at least two phases: one (identified by x-ray) is a jadeite that is nearly pure NaAlSi(2)O(6); the other has the chemical composition of oligoclase minus jadeite and appears to be largely amorphous.