Quality of life and pre-operative anxiety level in patients scheduled to undergo thoracic surgery.

PURPOSE: Increased preoperative anxiety levels may lead to adverse outcomes. We aimed at assessing the relationship between quality of life (QoL) and preoperative anxiety level during the 4-week preoperative period in patients scheduled to undergo thoracic surgery and we tried to identify patients who could benefit from preoperative supportive measures. METHODS: One hundred patients comprised the study population (52 men and 48 women) out of the initial 136, who were scheduled to undergo thoracic surgery. Mean age was 56±15 years (±SD). After obtaining informed consent, participants were asked to answer a questionnaire, through a personal interview, 12 to 15 h prior to their scheduled thoracic operation. The questionnaire included questions on demographics and incorporated the State Anxiety Inventory (STAI) and SF-36 scales. RESULTS: Female patients (p=0.023), unemployed patients (p=0.01) and patients that were scheduled for a mediastinoscopy (p=0.001) experienced increased anxiety level. Lower scores in several parameters related to the QoL were found to be associated with increased anxiety level. Limitations in patients' ability to work or to perform other everyday activities as a result of mental health problems (p=0.006), low vitality (p<0.001), bad general mood (p<0.001), deteriorated general health (p<0.001) and general mental health (p<0.001) were associated with preoperative anxiety. No differences were found in anxiety level among lung cancer and non-lung cancer patients. CONCLUSION: This study showed an inverse proportional correlation between preoperative QoL and anxiety during the 4-week period prior to thoracic surgery. Appropriate pharmaceutical and psychological support may improve patients' anxiety level.

Prospective monitoring of BK virus replication in renal transplant recipients.

BACKGROUND: BK virus-associated nephropathy (BKVAN) can be diagnosed only with renal graft biopsy. Definitive diagnosis of BKVAN requires demonstration of BK virus (BKV) replication in renal allograft tissues. Non-invasive analysis of urine and blood is considered essential in screening renal transplant recipients. PATIENTS AND METHODS: This study evaluated prospectively the replication of BKV in plasma and urine with qualitative and quantitative real-time polymerase chain reaction in 32 de novo (group A) and 34 chronic (group B) renal transplant recipients and the long-term impact on graft function. RESULTS: In group A, 456 samples (228 plasma, 228 urine) were examined and BKV was detected in 31 (31/228, 14%) samples of plasma and 57 (57/228, 25%) samples of urine in 20 (20/32, 62.5%) and 23 (23/32, 72%) recipients, respectively. Incidence of viremia and viruria increased during the first 6 months presenting a peak the third postoperative month (viremia: 28% and viruria: 31%). Immune suppressive treatment with tacrolimus showed significant relation with viremia. Renal graft function in de novo renal transplant recipients remained stable throughout the follow-up period without influence of BKV replication. In group B, incidence of viremia and viruria were 3% (1/34) and 9% (3/34) correspondingly, indicating that after the first post-transplant year the risk of BKV re-activation is diminished. CONCLUSION: The highest incidence of BK viremia and viruria is observed the third post-transplantation month, confirming previously published studies in Europe and the United States, and long-term follow up shows that BKV replication decreases significantly after the third post-transplant month and even transient viremia or viruria does not have an impact on renal function.

Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections.

In an open, randomized, parallel group study, the efficacy and tolerance of roxithromycin 300 mg po od was compared with clarithromycin 500 mg po bd in the treatment of 60 patients with lower respiratory tract infections (LRTI). The two groups were well-matched demographically. Fifty patients (25 per group) were clinically evaluable at the end of the study and a satisfactory response was found in 88% of those given roxithromycin and 80% of those given clarithromycin. All had received treatment for a minimum of 3 days. Only one (3.3%) of 30 patients in the roxithromycin group reported adverse events compared with seven (23.3%) of 30 in the clarithromycin group. Thus both roxithromycin and clarithromycin are effective in the treatment of LRTI but roxithromycin is better tolerated (P < 0.05) with the advantage of a once-daily dose.

Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece.

Ten cases of hydatid heart disease were treated over a 15-year period (1980-1995). Cysts were located in the left ventricular wall (four patients), right ventricular wall (one patient), interventricular septum (one patient), interatrial septum (one patient), right atrium (one patient), pericardial cavity (one patient) and in multiple loci (one patient). Apart from two asymptomatic cases, clinical manifestations included chest pain (four patients), anaphylactic shock (one patient), constrictive pericarditis (one patient), congestive heart failure (one patient) and arterial embolism (one patient). Computed tomography was found useful in the detection of hydatid cysts and also in the determination of their morphology. Magnetic resonance was performed in three patients, with satisfactory imaging. Three out of the 10 patients died: rupture of pulmonary echinococcal cyst (one patient), massive pulmonary hydatid embolism (one patient) and rupture of an undiagnosed hydatid cyst of the right atrium during cannulation for cardiopulmonary bypass (one patient). One other patient experienced recurrent systemic embolism and became hemiplegic. Six patients were successfully treated. In five patients, the cysts were excised by open heart surgery, while in one by pericardiectomy. In addition, antiparasitic drugs were successfully used in two patients with long-term satisfactory results. In conclusion, cardiac echinococcosis is associated with an increased risk of potentially lethal complications. Newer techniques of cardiac imaging have helped locate the cysts while surgical removal may offer cure. Some patients responded to specific long-term drug treatment.