Disentangling the effects of insomnia and night work on cardiovascular diseases: a study in nursing professionals

Cardiovascular diseases (CVDs) are known to be associated with poor sleep quality in general populations, but they have not been consistently associated with specific work schedules. Studies of CVD generally do not simultaneously consider sleep and work schedules, but that approach could help to disentangle their effects. We investigated the association between insomnia and a self-reported physician diagnosis of CVD in day and night workers, considering all sleep episodes during nocturnal and diurnal sleep. A cross-sectional study was conducted in 1307 female nursing professionals from 3 public hospitals, using baseline data from the “Health and Work in Nursing - a Cohort Study.” Participants were divided into two groups: i) day workers with no previous experience in night shifts (n=281) and whose data on insomnia were related to nocturnal sleep and ii) those who worked exclusively at night (n=340) and had data on both nocturnal and diurnal sleep episodes, as they often sleep at daytime. Multiple logistic regression analysis was performed. Among day workers, insomnia complaints increased the odds of CVD 2.79-fold (95% CI=1.01-6.71) compared with workers who had no complaints. Among night workers, reports of insomnia during both nocturnal and diurnal sleep increased the odds of reported CVD 3.07-fold (95% CI=1.30-7.24). Workers with insomnia had similar probabilities of reporting CVD regardless of their work schedule, suggesting a relationship to insomnia and not to night work per se. The results also highlighted the importance of including evaluation of all sleep episodes (diurnal plus nocturnal sleep) for night workers.

Disentangling the effects of insomnia and night work on cardiovascular diseases: a study in nursing professionals.

Cardiovascular diseases (CVDs) are known to be associated with poor sleep quality in general populations, but they have not been consistently associated with specific work schedules. Studies of CVD generally do not simultaneously consider sleep and work schedules, but that approach could help to disentangle their effects. We investigated the association between insomnia and a self-reported physician diagnosis of CVD in day and night workers, considering all sleep episodes during nocturnal and diurnal sleep. A cross-sectional study was conducted in 1307 female nursing professionals from 3 public hospitals, using baseline data from the "Health and Work in Nursing - a Cohort Study." Participants were divided into two groups: i) day workers with no previous experience in night shifts (n=281) and whose data on insomnia were related to nocturnal sleep and ii) those who worked exclusively at night (n=340) and had data on both nocturnal and diurnal sleep episodes, as they often sleep at daytime. Multiple logistic regression analysis was performed. Among day workers, insomnia complaints increased the odds of CVD 2.79-fold (95% CI=1.01-6.71) compared with workers who had no complaints. Among night workers, reports of insomnia during both nocturnal and diurnal sleep increased the odds of reported CVD 3.07-fold (95% CI=1.30-7.24). Workers with insomnia had similar probabilities of reporting CVD regardless of their work schedule, suggesting a relationship to insomnia and not to night work per se. The results also highlighted the importance of including evaluation of all sleep episodes (diurnal plus nocturnal sleep) for night workers.

Multicenter clinical experience with large core soft tissue biopsy without vacuum assistance.

The increasing interest in accurate pretreatment diagnosis of solid tumours by morphology, immunohistochemistry, genetics and molecular biology requires clinicians to obtain undamaged large core biopsies. Simultaneously, medical imaging and surgery give priority to minimal tissue injury, affordable technology and optimal patient compliance. A new large core soft tissue biopsy device has been developed to meet the above criteria. After intensive preclinical testing, 30 patients gave informed consent and 26 underwent the new diagnostic biopsy procedure. The sample was studied by morphology, immunohistochemistry and, where indicated, by molecular biology. Successful diagnosis was considered when in line with clinical follow-up and, as for all malignant lesions, when confirmed by open biopsy or surgery. No difficulties in the technique were encountered in 25 patients. In one patient the procedure was prematurely stopped because of anxiety. In all other 25 procedures a complete diagnosis was reached with regard to morphology, immunohistochemistry and molecular biology. A number of radiologists suggested some automation of the technique. This new large core soft tissue biopsy system performs well in the clinical context without injury to the breast parenchyma or artefacts in the harvested tissue specimen. The system meets almost all of the proposed technical and financial requirements. Automation is underway.

Patient compliance to instructions after oral surgical procedures.

The purpose of this study was to evaluate patient compliance to postoperative instructions from the oral surgeon. A total of 180 patients who underwent minor oral surgical procedures anonymously answered a questionnaire 1 week postsurgery. This questionnaire was used to evaluate how patients remembered the mode of transmission of instructions (written, verbal), their compliance to the postoperative instructions and to the antibiotic treatment and their comments. Of the patients, 40% did not remember receiving both written and verbal instructions, 36% remembered only the written instructions. Twelve percent did not comply with the postoperative instructions regarding mouthwashes and 67% did not comply with the antibiotic prescriptions; 43% took more antibiotics and 31% less, and 4% who did not receive an antibiotic prescription took them on their own initiative. The academic level of the patients did not influence patient compliance. Verbal and written recommendations worded simply with details are important for patient compliance and reduced postoperative stress and complaints. Better instructions on antibiotics use are necessary to ameliorate patient compliance to the antibiotic treatment.

[Gender and night work: sleep, daily life and the experiences of night shift workers]. / Gênero e trabalho noturno: sono, cotidiano e vivências de quem troca a noite pelo dia.

This paper deals with the impact of night work from a gender perspective, through a field study at a factory employing men and women on the night shift. It is based on data for hours of sleep over the course of several weeks, socio-demographic data, and job information, using a semi-structured interview. The methodology includes chronobiological aspects of sleep (mainly quantitative data) and workers' discourse concerning gender-related experiences in the day-to-night switch. Despite gender issues and differences in daily life, the switch is perceived quite vividly by both men and women, permeating several aspects of life, like health, leisure, studies, and intimate personal relations. Quantitative sleep analysis showed more severe effects of night work on women, especially those with children. Such sleep patterns were associated with different expectations among men and women, revealing gender issues that are essential for understanding the reality of individuals who work odd hours.

[Imaging mechanical complications of inferior vena cava filters]. / Imagerie des complications mécaniques des filtres caves inférieurs.

Filter placement within the inferior vena cava is performed to prevent pulmonary embolism in patients with contraindications or failure of anticoagulant therapy. Several complications of vena cava filters have been described. However, mechanical complications related to IVC filters may not be of any clinical significance. The purpose of this pictorial essay is to present the imaging features of complications related to inferior vena cava filter placement.

Gender and sleep in nightworkers: a quantitative analysis of sleep in days off.

Differences in sleep patterns between workdays and days off contribute to shiftwork effects on workers' health and well-being. But regardless of shift schedules, female workers face more difficulties in fulfilling their sleep need because of housework. This study analyzes gender differences concerning sleep in days off by comparing sleep patterns in male and female nightworkers, analyzing sleep as related to the presence of children and testing the association of sleep features between workdays and days off. Male (n = 16) and female (n = 30) workers at a plastic plant, working from 10 p.m. to 6 a.m., on weekdays, filled sleep logs for seven consecutive weeks. Male and female samples did not differ in length of night sleep or in total length of sleep. For both samples, sleep length/day in days off increased, but the difference was lager among females. Also important were the relations between sleep in workdays and days off, specially among women. Among female workers, the results indicated that workers with children tended to sleep less in Saturday mornings, suggesting a negative effect of motherhood on sleep not restricted to workdays. The general results indicate that sleep need on the one hand, and social factors on the other determine the actual amount of sleep.

Surgical management of macroglossia due to primary amyloidosis.

A case of macroglossia due to primary amyloidosis is described, followed by a discussion of the various aspects of surgical intervention based on a literature review.

[Imaging of a case of wirsungorrhagia]. / Imagerie d'une wirsungorragie.

We report a case of wirsungorrhagia related to rupture of a pseudoaneurysm into the duct of Wirsung in a patient with chronic pancreatitis. Upper gastrointestinal endoscopy showed blood coming from the papilla of Vater suggesting wirsungorrhagia. Non-contrast computed tomography showed a spontaneous hyperdensity and arteriography showed an extravasation of contrast within a very large duct of Wirsung confirming wirsungorrhagia. Arteriography and dynamic computed tomography revealed a pseudoaneurysm from the left gastric artery. The pseudoaneurysm was successfully embolized with four steel microcoils, after super-selective catheterization of small branch of the left gastric artery, keeping gastric and liver vascularization.

[Non-surgical treatment of biliary stenoses after hepatic transplantation]. / Traitement non chirurgical des sténoses biliaires après transplantation hépatique.

We report the initial and long-term results of non surgical procedures performed for the treatment of biliary strictures in liver transplant patients. Twelve liver transplant patients with biliary strictures underwent 16 interventional radiological procedures. Initial technical success was achieved in 11 of 12 patients (91%). Within long-term, with a follow-up of 27 months, primary success rate (only one procedure) was 58% (7 of 12 patients). Three restenoses occurred. They were all treated by interventional radiological procedures. The secondary success rate (one or more procedures) was 83% (10 of 12 patients). Two complications occurred including one pancreatitis and one cholangitis. Non surgical management may be performed for patients with biliary strictures after liver transplantation.

Circadian pattern of cercarial emergence in Schistosoma mansoni (Platyhelminthes:Digenea) from isolated Biomphalaria glabrata.

The present work aimed to compare the acrophases (peak hours) of emergence of Schistosoma mansoni cercariae among isolated individuals of the snail Biomphalaria glabrata. Laboratory stocks of melanic B. glabrata from the same biotope as the S. mansoni strain (Belo Horizonte, Minas Gerais) were used. Twenty-two snails individually exposed to five miracidia were tested. Chronobiological trials were performed outdoors after an acclimation period of at least a week. Three groups of snails were tested between November 1989 and April 1991. Cercarial emergence from individual isolated snails was quantified every 3 h for 3 consecutive days. In all trials, most cercariae were found to emerge during daytime (94.9%). Time series and chronograms showed recurrent peaks during the daytime. The periodogram suggested that 24 h was the period that best fitted cercarial emergence data in 90.9% of the snails. The single cosinor analysis confirmed 24-h rhythms in 95.5% of the snails. Acrophases of cercarial emergence among individual snails occurred between 14:15 and 17:02. They did not differ significantly. The population cosinor analysis indicated greater homogeneity in the 24-h rhythms of cercarial emergence than in the snail groups of each chronobiological trial. Acrophases of cercarial emergence occurred between 14:53 and 15:27 and did not differ significantly among all trials. Data from the three trials were pooled and analyzed using the population cosinor. This statistical method indicated a homogeneity in the 24-h rhythms of cercarial. emergence from all snails, with acrophase occurring around 15:00. Results showed that the acrophases of cercarial emergence of S. mansoni are similar among isolated B. glabrata specimens. Data support the hypothesis of a "gate" rhythm in the dynamics of cercarial production and emergence. It is suggested that the adaptive importance of the "gate" mechanism is associated with the concentration of cercariae in the water at times when the vertebrate is present, optimizing the contact between the parasite and the host. The emergence of some cercariae at night (5.1% of the total number of emerged cercariae) suggests a flexible "gate" that could be associated with a residual light effect or with experimental procedures in the laboratory.

Conversion disorder after maxillofacial trauma and surgery.

Three cases of conversion disorder are reported: one after orthognathic surgery and two after facial trauma. Two of the cases involved facial anesthesia and one case involved facial palsy. It was thought to be important to bring this phenomenon to the attention of oral and maxillofacial surgeons, to consider its management, and to define the patients with a high risk of developing conversion disorder. The prognosis is dependent on the circumstances of the onset of the disorder, the premorbid psychologic health of the patient, and how rapidly treatment is prescribed.

[Retroperitoneal vascular emergencies]. / Urgences rétropéritonéales vasculaires.

Ruptured abdominal aortic aneurysm is the major surgical emergency in the retroperitoneal compartment. Rupture of an abdominal aortic aneurysm is always fatal without urgent operative repair. Computed tomography is the reference standard for the diagnosis of ruptured abdominal aortic aneurysm in hemodynamically stable patients. At CT, the diagnosis is based on the combination of abdominal aortic aneurysm and extraluminal retroperitoneal blood. Retroperitoneal hemorrhage usually demonstrates both isodense and hyperdense areas. In most cases hemorrhage is located in psoas compartments and perirenal space. In the case of ruptured abdominal aortic aneurysm other findings may be demonstrated such as focal interruption of the aortic wall and active extravasation of contrast media in the retroperitoneal compartments. Inflammatory abdominal aortic aneurysm, that may present as acute abdominal pain, should be recognized and differentiated from ruptured abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm is characterized by a fibrotic process around the abdominal aorta that may entrap adjacent structures such as ureters, duodenum and inferior vena cava. Aortic dissection, mycotic aneurysm, and inferior vena cava thrombosis are less common. Complications occurring after emergency aneurysm replacement are also considered.

[Interventional radiology and abdominal emergencies]. / Radiologie interventionnelle et urgences abdominales.

Interventional radiology used in acute abdominal diseases has demonstrated its efficacy in most emergency cases especially in patients at high risk for surgery. Percutaneous drainage is a reference standard for abscesses located within the abdomen and pelvis with high success rates of up to 80%. The diagnosis and treatment of gastrointestinal hemorrhage have changed over the past two decades, with decreased diagnostic examinations and advances in pharmacologic therapy and improved endoscopic techniques. On the other hand, embolization techniques and new procedures such as trans jugular intra hepatic porto systemic shunt have been developed. Arterial embolisation in many situations such as blunt or direct trauma, obstetric or post operative hemorrhage, can be used as an effective easy and relatively safe technique with high success rates to stop bleeding and save the organ. Percutaneous drainage and angiographic techniques adapted to biliary and urinary tree have also been developed as well as endoscopic procedures, allowing treatment of stenoses by balloon dilatation, or plastic or metal prostheses. Indications, technical aspects, complications and limits of these various procedures are presented.

[Imaging of hepatic tuberculoma]. / Imagerie du tuberculome hépatique.

We describe a case of localized macronodular tuberculosis of the liver, the so-called hepatic tuberculoma. Liver US scan demonstrated an hypoechoic well-delineated lesion of the left liver lobe. Liver CT scan demonstrated a hypodense lesion before and after contrast enhancement. Liver MR scan demonstrated a lesion hypointense to liver on T1-weighted images and isointense to liver on T2-weighted images.

[Cervical pregnancy: conservative treatment with primary embolization of the uterine arteries. A case report. Review of the literature]. / Grossesse cervicale: traitement conservateur avec embolisation première des pédicules utérins. A propos d'un cas. Revue de la littérature.

Ectopic pregnancies are rarely located in the cervix. In most (50-70%) of the cases, haemostatic hysterectomy is usually performed. We attempted an original approach for ectopic pregnancies located in the cervix which allowed preservation of the uterus. The uterine arteries are embolized before evacuation of the pregnancy and haemostasis of the loge with a balloon probe. In the literature, the incidence has been reported at 1 cases/20,000 births. Past history of curetage is a favouring factor. Echography facilitates diagnosis. When possible, conservative treatment may involve surgery (arterial ligature, endocervical haemostasis), drug therapy (methotrexate) and radiography (arterial embolization).