Attitudes of dialysis patients and caregivers regarding advance directives.

OBJECTIVE: The objective of this study was to describe and compare the attitudes of dialysis patients, their relatives/friends, primary nephrologists, and nurses regarding advance directives. DESIGN: A descriptive comparative design was used. SAMPLE/SETTING: A total of 50 dialysis patients from a large teaching hospital in western Canada participated in the study. For every patient who responded, a relative/friend, physician, and nurse completed the questionnaire. METHODS: The questionnaires were designed for the purposes of the study. These questionnaires were mailed to dialysis patients, who were asked to identify a relative/friend to complete a similar questionnaire. Nurses and physicians also completed questionnaires. RESULTS: Overall, 84% of patients indicated that they believed that it was important to leave a living will, but only 18% of these patients had actually left an advance directive. However, 52% of patients and relatives/friends believed that major treatment decisions should be left to the physician, a perception that was not shared by physicians and nurses. CONCLUSIONS: It appears that patients, family/friends, nurses, and physicians in this study had differing perceptions regarding advance directives. It is important that health care professionals realize that these differences may exist and that further research should address strategies to increase our understanding of patient decisions in this area.

Experimental modes of Caryospora bigenetica (Apicomplexa: Eimeriidae) infection in swine and the effects of temperature and salinity on parasite infectivity in porcine tissue.

Four crossbred pigs (Sus scrofa) were inoculated orally with Caryospora bigenetica oocysts derived from snake and mouse feces, and with C. bigenetica infected mouse tissue. One pig also was given i.m. injections of methylprednisolone acetate. All four pigs displayed clinical signs including erythema, edema, and lethargy. Caryocysts were observed histologically in numerous tissues including ear, tongue, jowl, shoulder, loin, intercostal, ham, hock, and feet. The four pigs each were butchered into six commercial cuts: shoulder, loin, side, ham, hock, and feet. Raw 10 g samples from each cut were bioassayed by pepsin digestion and s.c. inoculation into 12 Swiss-Webster mice (Mus musculus) and 12 cotton rats (Sigmodon hispidus). Seventeen of 24 mice and cotton rats exhibited clinical signs and C. bigenetica tissue infections. Remaining portions of the six commercial cuts were temperature or saline treated, and 10 g samples were bioassayed in 16 mice and 12 cotton rats. No clinical sign or tissue infection was observed in these animals. Our study presents evidence that swine can be infected with C. bigenetica by ingesting oocysts present in snake feces or mouse feces (following inoculation of mice with snake-derived oocysts) or by ingesting C. bigenetica infected rodent tissue, that endogenously produced C. bigenetica oocysts are not excreted in the feces of swine, and that C. bigenetica in pork can be rendered noninfective by freezing at -20 degrees C (-4 degrees F) for 21 days, frying at 84 degrees C (183 degrees F) for 17 min, microwaving at 88 degrees C (190 degrees F) for 17 min, grilling at 82 degrees C (180 degrees F) for 48 min, baking at 95 degrees C (203 degrees F) for 230 min, boiling at 100 degrees C (212 degrees F) for 60 min, or by curing at 4 degrees C (39 degrees F) for 20 days.

Anaerobic corneal ulcers.

In a series of 162 bacterial corneal ulcers, 27 were culture positive for anaerobic organisms. Applying strict microbiologic criteria, 11 ulcers were determined to be due to anaerobic infection. No morphologic characteristic was identified to distinguish anaerobic from other types of corneal ulcers. All of the anaerobic ulcer patients manifested one or more predisposing factors. A total of 13 anaerobes were cultured from the 11 confirmed anaerobic ulcers. Five previously unreported anaerobic strains were identified as causes of bacterial keratitis. Over one third of the anaerobic organisms occurred in mixed cultures with other organisms. Most of the anaerobic isolates were susceptible to all antibiotics routinely used for their treatment. The use of topical chloramphenicol is recommended for treatment of confirmed anaerobic ulcers, and topical cefazolin or one of the other cephalosporins effective against anaerobes is suggested to be included in the treatment of all ulcers requiring broad spectrum antibiotic coverage.

Spontaneous subperiosteal orbital hematoma.

A case of spontaneous subperiosteal orbital hematoma is reported. The clinical differentiation of a subperiosteal orbital hematoma from an intraorbital hematoma is described. Although many "spontaneous" orbital hematomas have been associated with systemic and local orbital diseases, only 3 other truly spontaneous subperiosteal hematomas have been reported.

Ophthalmia neonatorum due to Chlamydia trachomatis: a family problem?

The most frequently seen type of infectious ophthalmia neonatorum, inclusion conjunctivitis, is caused by the organism Chlamydia trachomatis. This agent is known to be transmitted sexually. Until recently, the infections produced by C trachomatis were though to be relatively benign. Recent evidence, however, suggests that the organism may produce urethritis and epididymitis in the male; cervicitis, cervical erosions, salpingitis, and puerperal infections in the female; and prematurity and pneumonitis in the infant. An infant who develops ophthalmia neonatorum should be thoroughly evaluated for the presence of a chlamydial infection. In many instances the first evidence of chlamydial infection within the parents will be the development of inclusion conjunctivitis in their newborn infant. Family members of infants with inclusion conjunctivitis who manifest any evidence of clinical disease should be evaluated and treated with appropriate antibiotics.

Melnick-Needles syndrome.

A 10-year-old female with a generalized bone dysplasia was found to have a rare condition, Melnick-Needles syndrome. Characteristic clinical features of this syndrome include exophthalmos, hypertelorism, micrognathia, malaligned teeth, and large ears in a person with multiple bone deformities. In addition to the usual characteristic clinical findings, sclerocornea and cornea plana were also present in this patient. This is the first case of Melnick-Needles syndrome reported in the ophthalmological literature and the first case reported with ophthalmological findings other than exophthalmos and strabismus.

Preoperative topical antibiotics and lash trimming in cataract surgery.

Fifty patients admitted for cataract extraction had their lids and conjunctive cultured two days preoperatively, on the morning of surgery, and on each of the first four postoperative mornings. Multiple topical preoperative antibiotics given for forty-eight hours before surgery produced a marked reduction in the periocular bacterial flora, an effect which persisted throughout the postoperative period. Lash trimming prior to surgery did not alter the periocular bacterial flora present on the morning of surgery or at any time during the first four postoperative days. While multiple preoperative topical antibiotics may reduce the incidence of postoperative endophthalmitis through suppression of periocular bacterial flora, no such role can be postulated for lash trimming.