[Psychological traits, course of surgery and recovery following hernia repair in patients preferring general or local anaesthesia]. / Psychologische Persönlichkeitsmerkmale, Operationsverlauf und Genesung bei Patienten mit Präferenz für Allgemein- oder Lokalanästhesie: Untersuchung an Patienten mit Leistenhernienoperation.

OBJECTIVE: This study addresses two questions concerning open inguinal hernia repair patients: (1) are there differences in psychological traits between patients opting for local vs. general anaesthesia and (2) assuming comparable operations, are there any differences between the two groups during surgery and postoperative recovery? METHODS: A total of 69 male patients aged between 18 and 80 took part in the study. After having been briefed about anaesthesia, they opted for either local (n=40) or general anaesthesia (n=29). In order to determine psychological traits, patients filled out questionnaires before the operation [NEO Five-Factor-Inventory (NEO-FFI) and the Stress Coping Questionnaire (SVF)] and the Anaesthesiological Questionnaire (ANP) after the operation. Data about the surgery (duration of anaesthesia and operation, blood pressure and heart rate) and the convalescence period (time spent in recovery room, length of stay in hospital) were also recorded. The patients' information processing skills were measured preoperatively and postoperatively using the "Trail Making Test". RESULTS: Patients preferring local anaesthesia were significantly older than those who chose general anaesthesia. Therefore two similar age groups were formed by using the method of matched samples (n=2x26). Between these groups no significant differences were found with reference to psychological traits, but markedly extraverted patients favoured local anaesthesia. There were no differences in the duration of anaesthesia and surgery. Local anaesthesia patients spent less time in the recovery room and in hospital than general anaesthesia patients. Postoperatively, the cognitive state and the satisfaction with the anaesthesia were comparable between both groups. CONCLUSION: Psychological traits do not have a significant impact on the choice of either local or general anaesthesia. However, highly extraverted patients prefer local anaesthesia while extreme introverts prefer general anaesthesia. Our findings suggest that local anaesthesia will become more widely adopted for the repair of groin hernia. Future studies should focus on optimising the perioperative care for patients who choose local anaesthesia.

[Detection of human papillomavirus DNA in formalin fixed invasive squamous cell carcinoma of the larynx with polymerase chain reaction (PCR)]. / Der Nachweis humaner Papillomvirus (HPV) DNA in formalinfixierten invasiven Plattenepithelkarzinomen des Larynx mit der Polymerase Chain Reaction (PCR).

Approximately 67 different subtypes of HPVs have now been described. Regularly most of the cervical cancers are positive for HPV 16/18. Current research also indicates that HPVs may be involved in the development of benign tumours and also squamous cell cancers of head and neck. Studies establishing the presence of different HPV subtypes in oral cancers and precancers suggest the possibility of the virus as etiological factor in oral carcinogenesis too. In this study the prevalence of HPV 6/11, 16 and 18 infection and other exogenous risk factors like nicotine and alcohol in laryngeal cancers were studied. A total of 100 formalin-fixed and paraffin-embedded cancers, 41 glottic and 59 supraglottic, in patients aged 58 years, were detected by use of the E6 specific PCR for HPV DNA. Significantly more glottic cancers, 26 of 41 (63.4%), were positive for the investigated HPV's. HPV 16 was found in all positive cancers. This predominance of HPV 16 was also present in the supraglottic carcinomas, but only 10.2% (6 of 59) of the these groups were HPV positive. In both groups the patients with HPV 16 and/or 18 positive cancers, the exogenous risk factor was higher than with in HPV 16/18 negative tumours. Following infection, the virus either remains dormant or else undergoes active replication resulting in the synthesis of infectious virus. The integration of virus DNA into the host cell DNA may be the result of action of nicotine and/or alcohol. The integration event is the key of the carcinogenesis. The level of the risk factor in the patients with supraglottic tumours was significantly higher.(ABSTRACT TRUNCATED AT 250 WORDS)