[Survey of residents on their satisfaction after obtaining a hospital post]

BACKGROUND

To evaluate the degree of satisfaction of the resident physicians in an university hospital by the election of the speciality and the hospital, after the takeover of the workplace and in the course of their period of residence.

SUBJECTS AND METHODS

An anonymous questionnaire was distributed to the 164 residents of the hospital to know the concordance between the initial expectations of the residents and the degree of current satisfaction, about the specialty and the chosen hospital.

RESULTS

149 out of 164 residents (90.8%) answered the survey. In what is referring to the elected speciality, 57% (85 residents) expressed to be satisfied or very satisfied by their election; 22% (33 residents) felt indifferent, and 21% (31 residents) were unsatisfied or very unsatisfied. In what concerns to the chosen hospital, 43% (64 residents) were satisfied or very satisfied; 29% (43 residents) indifferent, and 28% (42 residents) were unsatisfied or very unsatisfied. With respect to the degree of satisfaction by the exercise of the profession at the moment of accomplishing the survey, 98% (143/149) of the residents answered, and of these, 30% (43 residents) expressed to be satisfied or very satisfied; 28% (40 residents), indifferent, and 42% (60 residents), unsatisfied or very unsatisfied. In the degree of satisfaction influenced in a statistically significant way the group of speciality chosen (medical, surgical or central services) after the examination and the moment of accomplishing the survey; the number of order of the residents examination; to have or not to have a speciality wished before of the residents examination, and the year of residence underway.

CONCLUSIONS

The degree of satisfaction of the resident physicians by the election of the speciality and of the hospital is relatively low. This fact outlines the suitability of the election system of the specialty.

Low apolipoprotein E epsilon4 allele frequency in the population of Catalonia (Spain) determined by PCR-RFLP and Laser fluorescent sequencer

Specific apolipoprotein E alleles have been associated in the last few years with several diseases using appropriate controls. However, these control groups are rarely representative of the general population since they correspond either to aged or healthy control groups (and thus depleted of pathological alleles). For this reason it is difficult at present to compare population allelic frequencies in different countries. In order to provide this essential basic data representative of the general population, in this work we have determined the distribution of apolipoprotein E alleles in 226 individuals from the population of Catalonia (Spain) sampled with the main purpose of paternity testing. The allelic frequencies are: epsilon2 = 0.064, epsilon3 = 0.810 and epsilon4 = 0.126, predicting a lower incidence of Alzheimer disease and possibly also of other pathologies where this allele is a risk factor.

Survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma: a comparative study

Cumulative recurrence after surgical resection for hepatocellular carcinoma (HCC) is very high. Several retrospective analyses have shown that liver transplantation was more effective than resection for patients with HCC at early tumor stages. Consequently, in January 1990, we decided to prospectively indicate orthotopic liver transplantation (OLT) as the first surgical treatment for small, localized HCC in cirrhotic patients without nodal involvement independently of the degree of liver function. The aim of this prospective cohort study was to analyze prognosis, recurrence rate, and survival after liver transplantation in patients in whom the main indication was HCC with cirrhosis. Thirty-eight patients in whom the main indication for liver transplantation was HCC and hepatic cirrhosis were compared with 136 transplantations because of cirrhosis without tumor, performed in our unit from January 1990 to December 1995. HCC arising in noncirrhotic livers and those incidently discovered after OLT were excluded from the study. Chemoembolization using doxorubicin, lipiodol, and Gelfoam was performed before OLT in 31 patients with good liver function. There were no differences in gender, but HCC patients were older (57 +/- 7 vs. 50 +/- 10 years [P < .001]). Liver function was better in HCC (Child-Pugh score: 6.9 +/- 2 vs. 8.6 +/- 1.8; P < .001), and hepatitis C virus antibody was positive in 31 (82%) vs. 51 (37%) (P < .007). Seven tumors had bilobar involvement (18%). Capsule was present in 22 (58%). The mean size of the tumor was 3.4 +/- 2 cm. Seventeen tumors (45%) were larger than 3 cm, and 4 (11%) were larger than 5 cm. The average number of nodules was 2 +/- 1. The tumor-node-metastasis stage of the tumors was pT1 in 6 patients (16%), 11 were pT2 (29%), 12 were pT3 (31%), and 9 were pT4 (24%). Seven patients were retransplanted in the HCC group (18%) and 19 (14%) in the nontumor group (not significant). Tumor recurrence was detected in three patients (8%). One, 3-, and 5-year survival rates were 82% vs. 79%, 75% vs. 71%, and 63% vs. 68%, respectively, for patients with and without HCC, and no differences were found between the two groups (P = .84). Survival was significantly reduced in patients with a macroscopic vascular invasion and tumors greater than 5 cm in diameter. Recurrence and mortality after liver transplantation in cirrhotic patients with carefully selected HCC are similar to the results in cirrhotic patients without tumor.

Glomerular proliferative activity and T lymphocyte infiltration in acute serum sickness

Because hypercellularity is an important feature in acute serum sickness (AcSS), we quantified glomerular proliferation with immunoperoxidase staining using anti-proliferating cell nuclear antigen (PCNA Mab) and studied its relationship with lymphocyte infiltration (M108 Mab). AcSS was induced in 31 New Zealand White rabbits; group A (n = 14), with proteinuria, sacrificed 6-8 days after immunization; group B (n = 10), without proteinuria, sacrificed 6-7 days after immunization; group C (n = 7), sacrificed prior to development of AcSS. Four normal rabbits were included as controls. Intraglomerular proliferation (PCNA-positive cells/glomerular cross section) was increased in group A (12.2 +/- SEM, 1.84) but not in groups B (0.93 +/- 0.17) and C (0.37 +/- 0.05), which were similar to controls (0.66 +/- 0.06). Lymphocyte infiltration (lymphs/glomerular cross section) increased with time and was more prominent in rabbits with proteinuria (1.9 +/- 0.21, P < 0.001 vs controls). Lymphocyte infiltration was correlated with proliferative activity (Spearman correlation, r = 0.67, P < 0.0001). There was correlation between the severity of glomerular deposition of IgG and C3 and glomerular proliferation and proteinuria. These studies demonstrate a chronological association between lymphocyte infiltration and proliferative activity in AcSS.

Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction

BACKGROUND

The surgical management of left colonic emergencies has evolved in the past few decades. Recently, there has been increasing interest in resection with primary anastomosis in selected cases. The aim of this study was to evaluate the differences in outcome in patients with peritonitis or obstruction treated by resection, on-table lavage and primary anastomosis of the left colon.

METHODS

Between January 1992 and August 1995, 212 patients underwent emergency operation for a distal colonic lesion: 97 presented with peritonitis, 113 with obstruction and two with other indications. Intraoperative colonic lavage was performed in 37 patients with obstruction and in 24 with an acute intra-abdominal inflammatory process.

RESULTS

The postoperative mortality rate was 5 per cent. The incidence of clinical anastomotic leakage was 5 per cent. Wound infection was observed in ten patients (16 per cent), more often in those with peritonitis (P = 0.03). The overall mean(s.d.) hospital stay was 15(9) days.

CONCLUSION

Resection, on-table lavage and primary anastomosis constitute the operation of choice for selected patients with left colonic emergency.

Population study of the HUMTH01, HUMVWA31A, HUMF13A1, and HUMFES/FPS STR polymorphisms in the north of Portugal

Allele and genotype frequencies of four short tandem-repeat loci were determined in a population sample from the North of Portugal using the polymerase chain reaction (PCR). After denaturing PAGE, 6 alleles were identified for HUMTH01 (n = 419), 9 alleles for HUMVWA31A (n = 376), 12 alleles for HUMF13A1 (n = 232), and 5 alleles for HUMFES/FPS (n = 409). No deviation from Hardy-Weinberg equilibrium was found. The allele frequencies observed are similar to those of the European populations compared. The combined power of discrimination is 0.999.

Population study of the STRs HUMCD4 and HUMF13A1 in Catalonia (Northeast Spain)

Allele and genotype frequencies were determined in a population sample from Catalonia (northeast Spain) for two short tandem repeat loci (HUMCD4 and HUMF13A1), using the polymerase chain reaction (PCR). After denaturing PAG electrophoresis, 6 alleles were identified for HUMCD4 in a sample of 157 unrelated individuals, and 11 alleles for HUMF13A1 in a sample of 141 individuals. No deviation from Hardy-Weinberg equilibrium was found. The HUMCD4 and HUMF13A1 loci demonstrated a heterozygosity of 0.6815 and 0.7305 respectively.

Hepatocellular carcinoma: iodized-oil CT TNM classification

OBJECTIVE

We conducted a prospective study to determine the efficacy of iodized-oil enhancement in CT for preoperative assessment of the T factor of the TNM classification in patients with hepatocellular carcinoma (HCC).

SUBJECTS AND METHODS

Iodized-oil CT was performed as a part of preoperative staging in 28 patients with HCC. We determined the radiologic T factor. Pathologic correlation was obtained after orthotopic liver transplantation (n = 25) or autopsy (n = 3), and the histologic T factor was determined.

RESULTS

The sensitivity of iodized-oil CT accurately distinguishing between stage-T4 tumors and tumors in stages T1-T3 was 88% (7/8) with a positive predictive value of 100% (7/7).

CONCLUSION

Iodized-oil CT is useful for preoperatively assessing the T factor of the TNM classification in HCC, and it improves the accuracy of radiologic staging. Iodized-oil CT can help to better patients with HCC for orthotopic liver transplantation.

[Surgical treatment of emergency pathology of the left colon]

The aim of this study was to evaluate the postoperative morbidity and mortality of patients with left colon disease that underwent emergency surgery. Intra-operative colonic irrigation (ICI) with primary anastomosis was used for unresectable lesions, faecal peritonitis, colon remnant associated lesions and poor performance status. The options included colostomy, Hartmann procedure or subtotal colectomy; 127 resections of left-sided large bowel were performed. In 56 cases the procedure was a Hartmann operation, in 38 cases subtotal colectomy and in 33 ICI. The most frequent complication was abdominal sepsis (29%). The overall mortality was 24%; 39% for the Hartmann procedure; 16% for subtotal colectomy and 6% for ICI. Our results suggest that ICI should be the first choice in patients with good performance status who undergo emergency surgery for left colon disease without faecal peritonitis or associated right colon lesions.

Population study of the STRs HUMTH01 (including a new variant) and HUMVWA31A in Catalonia (northeast Spain)

Allele and genotype frequencies for 2 short tandem repeat loci were determined in a population sample from Catalonia (Spain) using the polymerase chain reaction. After denaturing PAG electrophoresis, seven common and one variant (13.3) alleles were identified for HUMTH01 in a sample of 234 unrelated individuals, and seven alleles were found for HUMVWA31A in 162 individuals. No deviation from Hardy-Weinberg equilibrium was found. The observed heterozygosities are 76.92 and 79.62 respectively. The discrimination power determined for the individual loci is 0.928 and 0.937 respectively.

Study of three AMPFLPs (D1S80, 3'ApoB and YNZ22) in the population of the north of Portugal

Allele and genotype frequencies for D1S80, 3'ApoB and YNZ22 loci have been determined in a population sample of the North of Portugal using the polymerase chain reaction (PCR) amplification and nonradioactive detection. The distribution of genotypes in the three polymorphisms studied is in agreement with expected values according to the Hardy-Weinberg equilibrium. The combined chance of exclusion for the three systems is 0.96, and the combined power of discrimination is 0.99.

Detection of vertical transmission of human immunodeficiency virus type 1 by a commercial polymerase chain reaction assay

In a prospective study, a commercial polymerase chain reaction (PCR) system was compared with a conventional procedure, based on PCR and hybridization with a radio-labeled probe, for the detection of human immunodeficiency virus (HIV) infection in 131 blood samples from 80 children born to HIV-seropositive mothers. Twenty-three of these children were HIV infected. The sensitivity and specificity of the commercial assay as compared with the conventional PCR procedure were 100% and 95.1%, respectively. This commercial method simplifies the performance of the conventional PCR technique and can be used to detect HIV type 1 vertical transmission.

[Left hemicolectomy and intraoperative antegrade lavage in emergency surgery of the left colon]

We report our results with a left colonic resection and intraoperative antegrade colonic irrigation technique with primary anastomosis. Thirty five consecutive patients operated on in the Emergency Surgical Ward are presented. Twenty five with large bowel occlusion and 10 with sigma perforation. Anastomotic leakage (2 patients, 5.7%) and postoperative hospital stay (mean 15 days) were similar to cases of elective surgery. The intraoperative antegrade colonic irrigation technique has become the first choice in our Department to treat any patient with left colonic occlusion or perforation. Only patients with faecal peritonitis or ischemic colon were excluded.

Suitability of the YNZ22 (D17S5) VNTR polymorphism for legal medicine investigations in the population of Catalonia (Spain)

Allele and phenotype frequencies for the YNZ22 locus were determined in a population sample from Catalonia (Spain) using the polymerase chain reaction (PCR). In 311 unrelated individuals, 14 alleles and 56 phenotypes were observed. No deviation from Hardy-Weinberg equilibrium was found. The observed heterozygosity was 81.35%. The YNZ22 polymorphism is useful for paternity testing with a CE value of 70% and an Essen-Möller value of 9.35 (log.).

Microphakia associated with lens luxation in the cat

Congenital defects of the lens are rare in the cat. In this report, two unrelated Siamese kittens, a four-month-old male and a six-month-old female, with microphakia are presented. Abnormally small lenses were associated with elongation and rupture of the ciliary processes, leading to lens subluxations and subsequent anterior luxations. To the authors' knowledge, this condition has been reported only once previously.

Study of the 3'-ApoB minisatellite performed by PCR in the population of Catalonia (northeast Spain)

Allele and genotype frequencies for the 3'-ApoB locus were determined in a population sample from Catalonia (northeast Spain) using PCR amplification and nonradioactive detection. In a total of 308 unrelated individuals, 16 alleles and 50 genotypes were observed. The 3'-ApoB locus demonstrated a heterozygosity of 80%. The distribution of genotypes is in agreement with expected values according to the Hardy-Weinberg equilibrium.