健康体检人群恶性肿瘤的检出特点

目的回顾性分析健康体检人群中恶性肿瘤的检出特点,探讨如何提高健康体检人群中的恶性肿瘤检出率。方法以我院近5年健康体检人群140127例中发现并病理确诊的186例恶性肿瘤患者为研究对象。比较恶性肿瘤的检出与年龄、性别、地域等关系以及症状和实验室阳性结果对恶性肿瘤诊断的作用。结果病理确诊恶性肿瘤的检出率为0．133％（186例）。前5位恶性肿瘤依次为肺癌0．036％（51例）、肝癌0．017％（24例）、肾癌0．014％（20例）、结直肠癌0．013％（18例）和胃癌0．011％（16例）。186例恶性肿瘤中无症状者158例,占84．9％。超声对肝、肾、甲状腺癌等实质性脏器的灵敏度优于肿瘤标志物（TM）;将胸片、TM、症状和胸部低剂量CT相结合,可提高肺癌检出率。2008年消化道恶性肿瘤检出率高达0．083％,明显高于其他年度（χ2=11．792,P〈0．05）及当年度肺癌检出率（χ2=8．538,P〈0．05）。结论健康体检是早期发现恶性肿瘤的重要途径。由于体检发现的恶性肿瘤大部分无症状,而超声、胸片、TM和CT对恶性肿瘤的检出作用各有特点,充分发挥总检医生和检后随访的作用,将有助于提高恶性肿瘤的检出率。     

Ligasure™ Precise vs. Conventional Diathermy for Milligan-Morgan Hemorrhoidectomy: A Prospective, Randomized, Multicenter Trial

Purpose Milligan-Morgan hemorrhoidectomy using radiofrequency dissection (Ligasure™) has been proposed instead of conventional diathermy in view of its potential benefits in terms of postoperative anal pain and better hemostatic control, but the medical literature is still controversial. This multicenter, randomized, controlled trial was designed to compare the outcomes between Ligasure™ and conventional diathermy hemorrhoidectomy in the Milligan-Morgan procedures in a sufficient number of patients. Methods Patients with Grades III and IV hemorrhoids were randomized to two groups: Ligasure™ hemorrhoidectomy and conventional diathermy. Postoperative anal pain was measured by the Visual Analog Scale (VAS) and the analgesia required. Postoperative complications, wound healing, and return to working activities also were evaluated as secondary outcomes. Results A total of 273 patients, well matched for age, gender, working activity and grade of hemorrhoids, were randomized to two groups: Ligasure™ 146, and diathermy 127. The severity of postoperative anal pain was significantly less in the Ligasure group when measured at least 12 hours after defecation (P < 0.01), whereas it was similar at the time of defecation. The Ligasure™ group had significantly lower requirements for painkiller pills. There were no significant differences in early and late complications. Return to work and normal activities was significantly faster in the Ligasure™ group. Conclusion Ligasure™ hemorrhoidectomy is an effective procedure for Grades III and IV hemorrhoids and facilitates a faster return to work and normal activities by reducing postoperative pain. (Infantino A and Tonizzo CA,(Surgical Unit, Santa Maria dei Battuti Hospital, S Vito al Tagliamento, Italy), Picardo G, Buonanno M (Surgical Unit, Moscati General Hospital, Avellino, Italy), Binda GA (colorectal Unit Galliera Hospital Genova, Italy), Di Pascale A and Logrieco G (Surgical Unit Miulli General Hospital, Acquaviva delle Fonti, Italy), Gilbertoni F (Coloproctological Unit, Ramazzini Hospital, Carpi (Modena), Italy), Muzi PD (Dept of General Surgery, Tor Vergata University of Rome, Italy), Pezzolla F (IRCCS Castellana Grotte, Italy), Tegon G (Proctological Unit Rizzola Hospital, San Donà di Piave, Italy), Herbert Dal Corso Surgical Unit, Santa Croce Hospital, Cuneo, Italy) Reprints are not available.     

Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case–control study

Objective. To analyze risk factors for Pneumocystis carinii pneumonia (PCP) in kidney transplant recipients. Study design. In a case–control study, 17 PCP cases diagnosed between July 1994 and July 2000 were matched with two controls each (previous and subsequent kidney transplant recipients who did not develop PCP during the same follow‐up period). Demographics, organ origin, human leukocyte antigen (HLA) mismatches, use of poly‐ or monoclonal anti‐CD3 antibodies (Po/MoAb) for induction or rejection treatment, rejection episodes, cumulative steroid dose for rejection treatment, immunosuppressive regimens, and other infections were analyzed. Results. No significant differences were seen in gender (male 10 vs. 15), mean age (39.7 vs. 35.4 years), organ origin (cadaver donor 13 vs. 19), HLA mismatches, or Po/MoAb use in induction treatment. Significant differences were observed in PCP cases for rejection history (P=0.02), and median and total number of rejection episodes (P=0.0018). The relative risks for PCP for 1, 2, and ≥3 rejection treatments vs. no such treatment were 1, 1.05, and 6.30, respectively (P=0.021). The relative risk for PCP for steroid‐resistant rejection was 4.34 (95% confidence interval [CI], 1.04–18.89) (P=0.019), and that for the use of Po/MoAb for rejection treatment was 7.23 (95% CI, 1.28–49.34) (P=0.006). The relative risk for PCP for 0, 1, and ≥2 previous or concomitant cytomegalovirus (CMV) infection vs. no such infections were 1.0, 2.32, and 13.0, respectively (P=0.012). The relative risks for PCP for tuberculosis (TB) was 18 (95% CI, 1.76–852.03), that for bacterial pneumonia was 14.22 (95% CI, 2.16–150.23), and that for hepatitis C virus infection was 5.25 (95% CI, 1.03–28.91). Immunosuppressive regimens with tacrolimus, mycophenolate mofetil (MMF), steroids (P=0.06), and MMF as a single variable (P=0.05) were more frequently used in cases. Primary trimethoprim‐sulfamethoxazole prophylaxis failure was observed in 12 patients in association with heavy immunosuppression and concomitant infections. Conclusions. The risk of PCP in kidney transplant recipients is related to the number and type of rejection treatments. It is also related to the occurrence of CMV infection, and to other immunomodulating infections such as TB and hepatitis C, and might also be increased with the use of newer and more potent immunosuppressive agents. Primary prophylaxis failure may occur in association with some of these risk factors.     

Age effects in prospective memory performance within older adults: the paradoxical impact of implementation intentions

This study investigated age effects in prospective memory performance within older adults. The first aim was to explore this issue by examining event- and time-based prospective memory performance in two age groups: young-old (60–75 years) and old-old adults (76–90 years). Moreover, this study for the first time investigated whether forming implementation intentions could be used to improve prospective memory in young-old and old-old adults. Results showed a general effect of age in prospective memory performance for both task types. In addition, no general effect of implementation intentions in prospective memory performance across both task types and age groups was found. However, testing implementation intention effects separately for both age groups revealed that the formation of implementation intentions enhanced prospective memory only for the young-old adults, but did not substantially affect the performance in the time-based task and even impaired it in the event-based task for the old-old adults. Findings indicate that the formation of implementation intentions might be a powerful memory strategy for young-old adults, but not for the very old.

Trust and confidence: towards mutual acceptance of ethics committee approval of multicentre studies

AIMS: To compare issues raised by Human Research Ethics Committees (HREC) during the ethics review process and to determine the length of time taken to gain HREC approval for multicentre research studies. METHODS: Review and analysis of HREC documentation and correspondence for all multicentre research studies were conducted through three HREC under the auspices of Cancer Trials Australia, Melbourne, Victoria, Australia, between November 1997 and March 2001 to determine the variance of documentation, correspondence and recommendations across the three HREC and the time taken for study approval. RESULTS: Thirty-one projects were submitted to any two of the HREC (16 studies) or all three HREC (15 studies). The median time for study approval at an individual HREC was 75 days, but it was 111 days for approval at all participating sites. There were 554 clarifications or comments made by the reviewing HREC, the majority of which had no significant bearing on the ethical or scientific calibre of the study. There was only one study in which a significant protocol change was requested by a HREC. CONCLUSIONS: Multicentre study approvals are delayed when submitted to multiple HREC. The three HREC raised similar issues without substantive differences in their recommendations. A process for the mutual acceptance of HREC recommendations could facilitate multicentre research.     

Is CEA analysis of value in screening for recurrences after surgery for colorectal carcinoma?

The progress of 139 patients operated upon for cure of colorectal carcinoma, was followed postoperatively with a standardized protocol. A CEA test was performed for comparison with other parameters. Median observation time was four years. When an upper limit for CEA of 7.5 μg/l was allowed, sensitivity was found to be 78 per cent, specificity 91 per cent, and predictive value of an elevated CEA concentration, 83 per cent. In general, CEA measurement traced, recurrence six months before clinical diagnosis. In only a few cases was recurrence first heralded by an abnormality in other blood chemistry test results. CEA may thus be used in postoperative screening for recurrence even though most recurrences, when detected, are not curable. Read at the meeting of the American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 5–9, 1983 Presented in part at The World Congresses of Gastroenterology (OMGE) and Coloproctology, Stockholm, Sweden, June 14–19, 1982.     

Air pollution and pediatric respiratory disease: Croup

The question of a causative interrelation between air pollution and croup has received considerable attention by the mass media. A series of epidemiological studies has tried to establish a scientific basis for these speculations. Some studies have compared the occurrence of croup with locally measured concentrations of pollutants, while others have observed differences in the incidence of croup between populations subjected to different levels of pollution. Results have so far remained contradictory, most studies have failed to control for other variables, and thus clear-cut evidence for the etiologic role of air pollution has yet not been established on an epidemiological basis. On the other hand, simple croup is caused by viral infection, while recurrent croup is associated with allergy and airway hyperreactivity. Animal studies have documented that air pollution can reduce resistance against viral infections, increase the risk of allergic sensibilization, and induce airway hyperreactivity. Conceivably, air pollution could thus have a supportive role in the development of croup, but this possibility requires further investigation.