Comorbidity of insomnia detected by the Pittsburgh sleep quality index with anxiety, depression and personality disorders

BACKGROUND

The comorbidity of insomnia with various psychiatric conditions, such as anxiety, depressive and some personality disorders has been repeatedly shown in previous studies, although research investigating these disorders together is scarce.

METHOD

Two hundred and sixty five patients were interviewed individually. Two hundred and twelve of them completed the Pittsburgh Sleep Quality Index. They were also given the Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI 1 and 2), the Severity of Psychosocial Stressors Scale of DSM II R, and the Structured Clinical Interview of DSM II R for Personality Disorders (SCIDII) Personality Questionnaire.

RESULTS

There were no significant correlations between the patients insomnia scores and their gender, marital status, education, depression and trait anxiety scores, and stress levels. There were, however, significant associations of patients PSQI scores with their ages and STAI 1 scores.

CONCLUSIONS

When age, BDI scores, STAI 1 and 2 scores, education and stress level during the last year are accepted as factors that may have an impact on PSQI scores, it appears that a patients age and STAI 1 score best estimates his or her PSQI scores.

A comparison of spinal anesthesia with low-dose hyperbaric levobupivacaine and hyperbaric bupivacaine for transurethral surgery: a randomized controlled trial

BACKGROUND

The aim of this study was to compare spinal anesthesia effects of low-dose hyperbaric levobupivacaine and low-dose hyperbaric bupivacaine for transurethral procedures.

METHODS

In this double-blind, randomized, controlled study, a total of 60 patients who were ASA I-III were randomized into two groups. Group B received 7.5 mg hyperbaric bupivacaine plus 25 µg fentanyl, and Group L received 7.5 mg hyperbaric levobupivacaine plus 25 µg fentanyl intrathecally. The onset time to T10 dermatome, times to maximum sensory and motor block levels, time to two-segment regression of sensory block, time to Bromage score zero, time to full recovery of sensory block, and hemodynamic values, as well as adverse effects, were recorded. The primary outcome was the time to complete regression of motor block.

RESULTS

The onset time of block to T10, time to maximum sensory block, and time to two-segment regression were similar in both groups. The time to maximum motor block was shorter in Group B (7 ± 3 min) than in Group L (12±5 min), (P<0.001). The time to a Bromage score of zero (recovery of motor block) was shorter in Group L (105±19 min) than in Group B (113±7 min), (P=0.04). The time to full recovery of sensory block was shorter in Group B (127±14 min) than in Group L (157±34 min), (P<0.001). The requirement for analgesia was earlier in Group B (305±50 min) than in Group L (389±146 min), (P=0.004).

CONCLUSION

Although both techniques provide adequate spinal block and have few similar side effects for transurethral surgery, the use of low-dose hyperbaric levobupivacaine plus fentanyl may be preferable to low-dose hyperbaric bupivacaine plus fentanyl because of the reduced motor block, shorter duration of motor block, longer duration of sensory block and longer time to the first requirement for analgesia.

Aspergillus thyroiditis in a renal transplant recipient mimicking subacute thyroiditis

Fungal pathogens are increasingly encountered after renal transplantation. Aspergillus causes significant morbidity and mortality in transplant patients. Fungal thyroiditis is a rare occurrence owing to unique features of the thyroid gland. Most cases are caused by Aspergillus species and have been described in immunocompromised patients. Presentation may be identical with that of subacute thyroiditis, in which hyperthyroidism features and painful thyroid are the prominent findings. Diagnosis can be ascertained by fine-needle aspiration of thyroid showing branching hyphae of Aspergillus. We describe a renal transplant patient who developed Aspergillus thyroiditis as part of a disseminated infection successfully treated with voriconazole.

Successful Peritoneal Dialysis in a Hemophilia a Patient with Factor VIII Inhibitor

Chronic kidney disease and need for renal replacement therapy in hemophiliacs are relatively rare occurrences. Successful hemodialysis and peritoneal dialysis applications have been reported in the literature. We report a difficult-to-manage patient with hemophilia A plus factor VIII inhibitor who presented with gastrointestinal bleeding complicated by uremia. We admitted this hemophilia A patient with gastrointestinal bleeding who did not take regular factor infusions. He also had chronic kidney disease due to urinary stone disease. Since uremia might have contributed to bleeding, we chose hemodialysis along with factor VIII supplementation. His factor VIII and factor VIII inhibitor levels were 4% and 5 Bethesda units respectively. In order to bypass the inhibitor, we applied factor VIIA and prothrombin complex concentrate. After cessation of the hemorrhage, we placed a Tenckhoff catheter under prothrombin complex concentrate infusion. We did not observe any perioperative complication. To our knowledge, this is the first report of successful peritoneal dialysis in a hemophilia A patient who had factor VIII inhibitors.

Thoracic epidural anesthesia and blood glucose levels in diabetic patients undergoing cardiopulmonary bypass under insulin infusion according to the Portland protocol

BACKGROUND

We investigated the effect of thoracic epidural anesthesia on perioperative blood glucose levels in diabetic patients undergoing cardiopulmonary bypass by continuous insulin infusion according to the Portland Protocol.

MATERIAL AND METHODS

Diabetic patients undergoing surgery with cardiopulmonary bypass were assigned to receive either general anesthesia alone (n=40) or general anesthesia with thoracic epidural anesthesia (n=18). Patient data were retrospectively reviewed from prospective chart records used in our anesthesia clinic. In all study patients, insulin infusion with the Portland Protocol was used to maintain stable blood glucose levels. We evaluated blood glucose levels in both groups at 6 time points including before surgery, before cardiopulmonary bypass, during cardiopulmonary bypass, immediately following cardiopulmonary bypass, and on the first and second postoperative days. The amounts of insulin required at the intraoperative period and during two postoperative days were compared between two groups.

RESULTS

Groups were similar with respect to the duration of cardiopulmonary bypass, aortic cross-clamping, surgery, and blood glucose levels at any of the 6 time points, mean insulin requirements during intraoperative period and mean insulin requirements and blood glucose levels during the first 2 postoperative days (General anesthesia alone, 189+/-29 mg/dl vs. General anesthesia with thoracic epidural anesthesia, 191+/-19 mg/dl; p=0.782).

CONCLUSIONS

In diabetic patients undergoing cardiopulmonary bypass receiving insulin infusion by the Portland Protocol for glycemic control, thoracic epidural anesthesia provides no additional benefit for maintaining blood glucose levels during surgery.

Early maladaptive schemas activated in patients with obsessive compulsive disorder: A cross-sectional study

Aim. The aim of the present article is to investigate the activation patterns of early maladaptive schemas (EMSs) in patients with obsessive-compulsive disorder (OCD). Method. During the time between 1 January 2006 and 1 April 2006, 45 consecutive patients from an outpatient facility of a general hospital and 45 age- and gender-matched healthy control subjects from the hospital staff were included in the study. They were administered the Structured Clinical Interview for Diagnosis of DSM-IV Mental Disorders (SCID-1), the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-2), the Young Schema Questionnaire-Short Form (YSQ-SF), the Young Parenting Inventory (YPI) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The results were assessed using GraphPad Prisma V.3 statistical program. Results. The YSQ total score of the OCD group was significantly higher than the control group (t=3.62, P<0.0001). The average scores of the patients with OCD on certain schemas were significantly higher than the average scores of the control group, although the others did not make any difference between the OCD and control groups. Conclusion. The study demonstrates that, in the patients with OCD, most of the early maladaptive schemas including social isolation, vulnerability and pessimism, are prominently activated.

[Two cases of koro syndrome or anxiety disorder associated with genital retraction fear]

As a cultural-bound syndrome, koro is described in the DSM-IV as "an episode of sudden and intense anxiety that the penis (or, in females, the vulva and the nipples) will recede into the body and possibly cause death." Sometimes the syndrome may occur as an epidemic involving several hundreds to thousands of subjects within a short period of time. While the syndrome individually involves an anxiety reaction and fear of mortal genital retraction, it collectively takes the form of epidemics and mass panic. Recently a consensus has been reached about the fact that genital retraction is intimately related not only with ethno-cultural beliefs but also with the dramatic expression of acute anxiety and fear of impending catastrophe or death. We present two cases of koro syndrome who experienced severe anxiety due to the feeling of genital retraction and thus we question the cultural specifity of fears of genital retraction.

Treatment with antidepressive drugs improved quality of life in chronic hemodialysis patients

BACKGROUND

Despite some improvements in dialysis therapies, depression still remains an important problem in chronic hemodialysis (HD) patients. In this study, we aimed to investigate the association of depression and its treatment with quality of life (QOL) in HD patients.

PATIENTS AND METHODS

97 HD patients (52 male, 45 female, mean age 55 +/- 16 years) were enrolled. All patients had been dialyzed for more than 6 months. In order to evaluate QOL of the patients, a short form of Medical Outcomes Study (SF-36) was used. Depression was assessed by using Beck Depression Inventory (BDI). Patients who had BDI score > or = 15 were diagnosed as to have depression. Patients with depression received antidepressive treatment (sertralin HCl, 50 mg/day) for an 8-week period. After 8-week antidepressive treatment, all biochemical analysis, SF-36 and BDI were performed again.

RESULTS

40 patients (20 male, 20 female, mean age 56 +/- 14 years) had depression. All parameters related to QOL were significantly decreased in patients with depression as compared to patients without depression. Severity of depression was correlated with QOL parameters. After 8 weeks of treatment, as parallel to changes in BDI, QOL parameters improved in patients with depression.

CONCLUSION

Decrease in QOL, associated with depression and antidepressive treatment, improves QOL in HD patients. Hemodialysis patients should be followed-up closely for presence of depression. Treatment of depression with antidepressive drug regimen would lead to relieve the symptoms related to depression and improvement of QOL in these patients. Antidepressive treatment should be required more often than we prescribe in routine clinical practice now.

Valve Replacement Surgery in Patients With End-stage Renal Disease: Long-term Results

BACKGROUND

The life expectancy of patients with chronic renal failure who are dependent on dialysis is very poor. This study was undertaken to determine time-related outcomes in dialysis patients requiring cardiac valve replacement.

METHODS

From 1994 to 2001, 29 end-stage renal disease (ESRD) patients on hemodialysis (HD) program underwent 30 valve replacement operations: 29 received mechanical valves (97%), and one received bioprosthetic valves. The sites of valve replacement were 11 aortic (36.7%), 18 mitral (60%), and one both aortic and mitral (3.3%). Mean age was 42.46 +/- 14.26 years (range 17-75 years). Follow-up was completed in 28 patients (96.5%).

RESULTS

Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan-Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the follow-up period. All patients, except the one with bioprosthesis, used warfarin sodium for anticoagulation and none of them had bleeding. One of the patients had a major cerebrovascular accident (CVA) and another one had a minor CVA at the follow-up (6.7%).

CONCLUSIONS

Life quality is better and life expectancy is longer after valve replacement in ESRD patients who have valvular disease. Also, longer life expectancy increases the probability for finding donors for kidney transplantation.

Does ischemia-induced prostate damage during cardiac surgery involving cardiopulmonary bypass cause bladder outlet obstruction?

OBJECTIVE

This study sought to investigate whether ischemia-induced prostate damage during cardiac surgery involving cardiopulmonary bypass causes bladder outlet obstruction.

MATERIALS AND METHODS

The study involved 37 men who underwent elective cardiac surgery involving cardiopulmonary bypass. Prostate-specific antigen (PSA) levels were determined preoperatively (baseline) and on postoperative days 1, 5, and 30. In 4 cases, the PSA level after the operation was unchanged from the preoperative level, so these 4 men were excluded from the study. In the remaining 33 patients, symptoms of bladder outlet obstruction were assessed using the International Prostate Symptom Score. Each subject completed this test preoperatively and 3, 6 and 9 months postoperatively, and the means scores at these time points were compared. The effects of patient age, operative time, CPB time, and aortic clamping time on postoperative increases in PSA levels were investigated.

RESULTS

Thirty-three (89.2%) of the 37 men exhibited increased postoperative PSA levels compared to baseline. The mean PSA level for the 33 cases on day 5 was significantly higher than the baseline mean, but the mean levels on postoperative days 1 and 30 were comparable to baseline. Nine (24.3%) of the 33 men had postoperative PSA levels greater than 4.0 ng/dl (the upper normal limit). There was no significant difference between preoperative and postoperative International Prostate Symptom Scores.

CONCLUSION

The study indicates that men's PSA levels are, indeed, increased after cardiac surgery with cardiopulmonary bypass. However, in 9 months of follow-up, there was no association between this PSA rise and development of BOO, according to International Prostate Symptom Scores.

Effect of coronary artery bypass grafting and aneurysmectomy on QT dispersion in moderate or severe left ventricular dysfunction

BACKGROUND

The aim of the study was to evaluate the effect that coronary artery bypass grafting (CABG) and aneurysmectomy in the same session have on QT dispersion (QTd) in moderate or severe left ventricular dysfunction.

METHODS

Forty-four patients underwent QT interval analyses before and 1 month after aneurysmectomy and CABG. QT interval and QTd were corrected for heart rate using the square root formula of Bazett (QTCB), the cubic root formula of Fridericia (QTCF), and the linear formula of Sagie et al (QT CS ).

RESULTS

The mean pre- and postsurgery QTd results were 65.29 +/- 29.25 and 51.76 +/- 18.49 milliseconds, respectively; the corresponding findings for QT CF were 68.06 +/- 31.26 and 55.16 +/- 24.56 milliseconds; and the corresponding findings for QT CS were 66.53 +/- 32.22 and 51.10 +/- 18.29 milliseconds. With these 3 methods, the postoperative findings were significantly lower than the preoperative findings ( P < .05 for all). In contrast, the opposite was true with the QT CB method (preoperative 71.1 +/- 65.80 vs postoperative 76.43 +/- 7.96 milliseconds, P < .05).

CONCLUSION

The study showed that based on the methods of Fridericia (QT CF ) and Sagie et al (QT CS ), QT intervals are significantly decreased after CABG and aneurysmectomy.

Surgical Treatment of a Huge Cavernous Hemangioma Surrounding the Right Coronary Artery

Hemangioma of the heart is an extremely rare benign cardiac tumor. A 61-year-old woman presented with a huge hemangioma on the right ventricle. The tumor was completely surrounding the right coronary artery. Under cardiopulmonary bypass, the right coronary artery was transected from the aortic sinus and the supplying arteries of the tumor were divided. The tumor was successfully resected, and the right coronary artery was reanastomosed to the aortic sinus.

Does Rigid Bronchoscopy Induce Bacterial Translocation?

BACKGROUND

Although some reports suggest that bronchoscopy induces bacterial translocation (BT), the mechanisms of BT remain unclear.

OBJECTIVE

We aimed to assess whether bronchoscopy or hypoxemia during bronchoscopy is responsible for BT.

METHODS

We evaluated 24 rats divided into three subgroups: the control group (group 1, n = 8); the rigid bronchoscopy group (group 2, n = 8), and the group receiving bronchoscopy + mechanical ventilation (group 3, n = 8). Oxygen saturation (SaO(2)) was measured during the bronchoscopic procedure. Blood and tissue cultures from mesenteric lymph nodes (MLNs), liver, spleen and cecal contents were obtained 24 h following bronchoscopy.

RESULTS

In group 2, SaO(2) was significantly lower than in groups 1 and 3 (p < 0.01). In group 2, BT significantly increased (6/8, 75%; p < 0.01 vs. group 1, and p < 0.05 vs. group 3). The main site of translocation was MLNs (6/8, 75%) in group 2, while BT was detected in only 1 rat in group 3 (1/8, 12.5%).

CONCLUSION

Hypoxemia during rigid bronchoscopy resulted in intestinal mucosal damage in a rat model. Hypoxemia may have been the trigger for BT from the intestine following bronchoscopy.

Simultaneous toxicity and nutrient removals in simulated DEPHANOX (anaerobic/anoxic/oxic sequentials) process treating dinitrotoluene and trichlorotoluene

A modified DEPHANOX process including two upflow sludge blanket reactors (USB) (anaerobic-upflow sludge blanket -UASB and anoxic-upflow anoxic sludge blanket -UA(N)SB) and one completely stirred tank reactor (CSTR) system was simulated in order to detect the simultaneous removal of dinitrotoulene (DNT), trichlorotoluene (TCT), and nutrients. The phosphorus uptake and nitrification was excessively determined in aerobic CSTR reactor. Influent DNT was transformed to toluene, NH4-N and total aromatic amines (TAA) while TCT was transformed to toluene and dichlorotoluene (DCT) under anaerobic and anoxic conditions. Increasing the volumetric loading rate of DNT and TCT from 18 mg/L x day and 0.35 g/L x day to 60 mg/L x day and 1.2 g/L x day, respectively, resulted in higher COD conversion (70-80%) rates and methane productions (250-300 ml/day) in anaerobic reactor. 90% NO3-N and 87% PO4-P were achieved in anoxic and aerobic reactors at DNT and TCT loading rates as high as 40-60 mg/L x day and 0.8-1.2 g/L x day, respectively. The TAA produced under anaerobic and anoxic conditions were ultimately removed under the aerobic stage. The UASB and anoxic UASB reactor effluents were less toxic relative to the influent when analyzed by anaerobic toxicity tests and specific methanogenic activity tests, indicating that such anaerobic/anoxic aerobic sequential treatments could be able to reduce toxic organics together with nutrient removal.