Postoperative pain management—clinical practice is still not optimal

Major progress in clinical pain assessment and management has been achieved in the last decade. More effective analgesic drugs and improved techniques for pain management have been introduced. However, medical reports published during the last few years on postoperative pain management (POPM) indicate that moderate or even severe pain is still rather commonly experienced by surgical patients in the early postoperative period and that worst-pain-episodes may occur even in the late postoperative phase. Insufficient relief of postoperative pain seems a more common problem on surgical wards than on a postanaesthesia care unit (PACU). The aims of POPM are to inhibit autonomic trauma-induced nociceptive impulses that may result in functional disturbances of vital organs and thereby affect the incidence of potentially severe complications influencing clinical outcome. Considering that recent studies continue to show sub-optimal pain management despite the availability of effective drugs and analgesic techniques it must be considered essential to identify possible barriers to effective pain management in clinical practice so that necessary improvements in POPM routines can be carried out.     

Die Lipoide der weißen Hirnsubstanz während der Autolyse und bei der anämischen Erweichung

Zusammenfassung Während der sterilenAutolyse der weißen Hirnsubstanz bis zu 24 Tagen verändern sich die Lipoide nur geringfügig. Die erst vom 9. Tage an verstärkte Abnahme des Lipoid-P beruht auf der Spaltung von Lecithin und Plasmalogen und wird von einer entsprechenden Zunahme freier Fettsäuren (FFS), geringerer der Aldehyde begleitet. FFS sind in der frischen weißen Substanz nur in Spuren nachweisbar. Lysophosphatide treten—im Gegensatz zu anderen Organen—in papierchromatographisch nachweisbarer Menge nicht auf. Cholesterin und seine Ester bleiben unverändert. Kephaline, Inositphosphatide, Sphingomyelin, Cerebroside und Sulfatide verhalten sich chromatographisch weitgehend konstant. Die postmortale Autolyse hat bis mehrere Tage nach dem Tode keinen nennenswerten Einfluß auf die Lipoidzusammensetzung.Bei der Untersuchung von 20 verschiedenenErweichungsherden des Gehirns fand sich eine vom Alter der Herde nicht unbedingt abhängige Zunahme der FFS, Aldehyde, Triglyceride und Cholesterinester. Freie wie auch glycerid- und cholesteringebundene Fettsäuren und freie höhere Aldehyde stammen offensichtlich aus den strukturbildenden Lipoiden des Myelin. In verschiedenen Herden treten spurenweise Lysophosphatide auf.

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Summary Lipides change slightly during sterile autolysis of human white matter up to the 24 th day. From the 9 th day on, there is a decrease of lipid-phosphorus caused by a breakdown of lecithin and plasmalogen accompanied by a comparable increase of free fatty acids (FFA) and aldehydes. In fresh white matter there are only traces of FFA. In the autolysing brain, contrary to several other autolysing organs, there are no lysophosphatides detectable by means of paper chromatography. Free and esterified cholesterol, cephalins, phosphoinositides, sphingomyelin, cerebrosides and sulfatides remain chromatographically constant during sterile autolysis. According to the above findings it can be concluded that postmortem autolysis up to several days duration has only neglectable effects on the lipid-composition of the white matter.After analysis of 20 different foci of anaemic softening of human brain we found an increase of FFA, aldehydes, triglycerides and of esterified cholesterol which is independent on the age of the lesion. FFA as well as those fatty acids which are bound to glycerol and cholesterol and free higher aldehydes derive from the myelin lipides. Also in contrast to autolysis there were traces of lysophosphatides found in several foci.

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Herrn Prof. Dr.E. Letterer zum Geburtstag am 30. Juni 1966 gewidmet.

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Mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

A Psychoneuroendocrino-immune approach in the nursing treatment of anorexia and bulimia nervosa

Recent clinical reports have shown an increasing number of patients afflicted by eating disorders in the western world. There are numerous causes and mechanisms leading to eating disorders that affect the psychoneuroendocrinoimmune system. In this study, we define a novel psychoneuroendocrinoimmune nursing approach for anorexic and bulimic patients’ treatment. According to the specific diagnostic items deriving from the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, and clinical guidelines in eating disorders formulated by the National Institute for Clinical Excellence, we carried out a qualitative study on the nursing treatment chosen by 210 international centers considered as a sample. This study was based on a no structured interview via e-mail to better understand the nursing approach in anorexia and bulimia nervosa. Thanks to the selected centers’ answers, four different levels of nursing care were identified, that include:

1. the nursing role analyzing the spectrum of patients’ problems;

2. the nursing intervention in inpatient care;

3. the nursing intervention in outpatient care;

4. the day hospital treatment.

All four prove to be especially useful in the nursing practice.     

Adjacent parenchymal abnormalities in peripheral bronchogenic carcinoma: correlation of thin-section CT with histology

Our purpose is to correlate thin section CT of peripheral bronchogenic carcinomas with histologically detected lymphatic or vascular invasion. Retrospective 3-year database search revealed 186 surgical resections for primary bronchogenic carcinoma, of which 58 had available preoperative imaging performed at our institution. Cases with prior surgery, nonconfirmatory pathology, remote imaging, or central location were excluded, resulting in a study population of 42 patients, 25 men, 17 women, with a mean age of 69 years. Imaging with 1-3 mm collimation was performed within a mean of 32 days prior to surgery. Histologic diagnoses included adenocarcinoma (n = 24, 57%), squamous cell carcinoma (n = 13, 31%), large cell carcinoma (n = 4, 10%), and small cell carcinoma (n = 1, 2%), with a mean tumor size of 27 mm. Three radiologists blindly and independently recorded bronchovascular thickening, septal and nonseptal opacities, and the extent of each beyond tumor margins: 1) <5 mm, 2) 5-10 mm, and 3) >10 mm. Lymphangio-invasion was correlated with imaging findings, tumor size, and histology. Adjacent parenchymal abnormalities were recorded in 40 (95%) of 42 masses, with isolated nonseptal opacities representing the most frequent abnormality in 21 (50%), followed by bronchovascular thickening in 16 (38%), and septal opacities in 12 (29%). Lymphangio-invasion was present in 16 (38%) of cases. The frequency of lymphangio-invasion was highest (53%) in cases with 2 or more positive findings, and extension beyond 10mm from the tumor margin. This trend did not achieve statistical significance by ROC analysis. Lymphangio-invasion was positively correlated with tumor size, P =.03, but not histology.In conclusion, parenchymal abnormalities beyond tumor margins shown by CT may be due to lymphangio-invasion but imaging findings did not reliably distinguish cases with and without lymphangio-invasion.     

Satisfaction with Housing and Housing Support for People with Psychiatric Disabilities

The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as other's influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.     

Sperm DNA damage in patients with chronic viral C hepatitis

Introduction

The aim of this study was to evaluate the conventional and biofunctional parameters of sperm in young infertile patients with Hepatitis C (HCV) infection.

Methods

Forty HCV patients with primary infertility, aged 27 to 42 years (mean 36.4 years) and twenty HCV patients with secondary infertility aged 28 to 45 years (mean 35.0 ± 2.8 years), underwent hormonal and sperm analysis in addition to the determination of reactive oxygen species (ROS) concentrations in the sperm and flow-cytometric evaluation. The following biofunctional sperm parameters were evaluated by flow cytometry: DNA fragmentation, mitochondrial membrane potential, chromatin condensation, and the rate of early apoptosis.

Results

Overall, patients with HCV showed significantly worse median values of conventional and biofunctional sperm parameters than control subjects, including sperm density (31.7 vs. 80.4 million/ml), forward motility (9.4 vs. 25%), normal forms (15.4 vs. 24.8%), DNA fragmentation (6.6 vs. 2.2%), low MMP (45.5 vs. 8%), an early apoptosis rate (5 vs. 2.7%), and abnormal chromatin (18.9 vs. 13.9%). Finally, HCV patients had significantly higher basal (250 vs. 75 × 10³/cpm) and stimulated (550 vs. 120 × 10³/cpm) ROS levels in semen compared to control subjects. None of the examined parameters (sperm, hormonal, biofunctional and assessment of oxidative status in the semen) was significantly different between HCV patients with primary and secondary infertilities.

Discussion

These results confirm that HCV infection has a negative impact on sperm parameters. The overlap of the results observed in the two groups of HCV patients supports the hypothesis that HCV infection may cause to alterations in sperm parameters.