Diagnostic Value of Urine Sodium Concentration in Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion Versus Hypovolemia

Background

We are often left with the differential diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) versus hypovolemic hyponatremia. It is difficult to tell who will respond to isotonic saline infusion and who will not, if the urine sodium value is not completely suppressed (>10 mEq/L).

Aim

To examine the diagnostic accuracy of the urine sodium value.

Design

A retrospective observation.

Methods

The diagnostic accuracy of the urine sodium value was compared to that of a complete work-up and hospital course, including a response to saline infusion in patients with a final diagnosis of SIADH or hypovolemic hyponatremia. We also examined the diagnostic value of urine sodium-to-BUN ratio which should improve separation between SIADH and hypovolemia since the urine sodium and BUN move in opposite directions in these two conditions.

Results

The urine sodium value of 50 mEq/L was the most accurate in separating SIADH from hypovolemic hyponatremia: sensitivity 0.89, specificity 0.69, and accuracy 0.82. The diagnostic utility for SIADH versus hypovolemia, as quantified by the areas under the ROC curves, was not statistically different between urine sodium alone (0.89, 95% CI 0.77–0.96) and urine sodium-to-BUN ratio (0.93, 95% CI 0.83–0.98); p-value 0.33.

Conclusions

When the underlying cause is inconclusive between SIADH and hypovolemia, and when only basic laboratory results are available at the time of initial evaluation, the urine sodium alone will be adequate to guide initial fluid management. In contrast to traditional teaching, elevated urine sodium levels up to 50 mEq/L demonstrated clinically meaningful responses to isotonic saline infusion.     

Intussusception as a Cause of Bowel Obstruction in Adults from a Resource Limited Area,Cameroon

Background

Intussusception refers to the telescoping of a proximal segment of bowel into a distal segment. It is a rare cause of intestinal obstruction in adulthood.

Case Details

We report two cases of adult intussusception in a post-operative period following Caesarean Section (with no lead point) and Appendicectomy (due to colonic adenocarcinoma) respectively.

Conclusion

Though rare in adulthood, intussusception should be considered as a differential diagnosis to bowel obstruction in adults even in the post-operative period.     

Intake of Soy Products and Other Foods and Gastric Cancer Risk: A Prospective Study

Background

Gastric cancer, the most common cancer in the world, is affected by some foods or food groups. We examined the relationship between dietary intake and stomach cancer risk in the Korean Multi-Center Cancer Cohort (KMCC).

Methods

The KMCC included 19 688 Korean men and women who were enrolled from 1993 to 2004. Of those subjects, 9724 completed a brief 14-food frequency questionnaire at baseline. Through record linkage with the Korean Central Cancer Registry and National Death Certificate databases, we documented 166 gastric cancer cases as of December 31, 2008. Cox proportional hazard models were used to estimate relative risks (RRs) and 95% CIs.

Results

Frequent intake of soybean/tofu was significantly associated with reduced risk of gastric cancer, after adjustment for age, sex, cigarette smoking, body mass index, alcohol consumption, and area of residence (P for trend = 0.036). We found a significant inverse association between soybean/tofu intake and gastric cancer risk among women (RR = 0.41, 95% CI: 0.22–0.78). Men with a high soybean/tofu intake had a lower risk of gastric cancer, but the reduction was not statistically significant (RR = 0.77, 95% CI: 0.52–1.13). There was no interaction between soybean/tofu intake and cigarette smoking in relation to gastric cancer risk (P for interaction = 0.268).

Conclusions

Frequent soybean/tofu intake was associated with lower risk of gastric cancer.Key words: soybean, dietary intake, gastric cancer     

Exposure to PM10 as a risk factor for the development of nasal obstruction and chronic obstructive pulmonary disease

Objectives:

To investigate whether air pollution is a potential risk factor for airways obstruction.

Methods:

A prospective cohort study (11.3±2.9 years) that took place in two areas (Eordea where concentration of PM₁₀ was high and Grevena, Greece). We used the MRC questionnaire, spirometry, and anterior rhinomanometry at both visits.

Results:

Initially we examined 3046 subjects. After excluding chronic obstructive pulmonary disease (COPD) patients, we re-examined 872 subjects and 168 of them had developed COPD (Grevena: 24.3%, Eordea: 18.5%). Multivariable logistic regression analysis showed that the area of residence and thus exposure to air pollution was not a risk factor for the development of COPD (OR: 0.51, 95% CI: 0.18–1.46, P = 0.21). On the other hand, residence in Eordea was strongly related to the development of severe nasal obstruction (OR: 11.47, 95% CI: 6.15–21.40, P<0.001). Similar results were found after excluding patients with COPD stage I as well as in the subgroup of never smokers.

Conclusion:

Air pollution was associated with severe nasal obstruction but not with COPD development.     

A Brodie's Abscess of Femoral Neck Mimicking Osteoid Osteoma: Diagnostic Approach and Management Strategy

Background

Brodie''s abscess usually presents as a diagnostic dilemma resulting in a diagnostic delay. It mimics various benign and malignant conditions both clinically and radiologically.

Case Details

This report describes a case of a 14 year old boy who presented with a clinical and radiological picture of osteoid osteoma of proximal femur but found to have a brodie''s abscess on histology and culture.

Conclusion

It describes the clinical spectrum of subacute osteomyelitis, its unusual MRI features and the importance of obtaining a histological diagnosis before definitive treatment.     

Differences in the Levels of Gastric Cancer Risk Factors Between Nanjing and Minqing Counties,China

Objectives:

In Fujian Province, China, gastric cancer is one of the leading causes of mortality among all malignant tumors. Nanjing county and Minqing county are located in inland Fujian and have similar general demographics. However, the adjusted mortality rate of gastric cancer in Minqing was found to be much higher than that in Nanjing. We sought to explore factors associated with this increased risk of gastric cancer between the two counties.

Methods:

We recruited 231 and 224 residents from Nanjing and Minqing, respectively, and analyzed differences between their dietary habits, Helicobacter pylori infection rates, and concentrations of serum pepsinogen I, pepsinogen II, gastrin-17, and ratio of pepsinogen I:II.

Results:

Subjects in Minqing had more first-degree relatives who had been diagnosed with upper gastrointestinal tumor, more unhealthy dietary habits, a higher Helicobacter pylori positive rate, and greater proportion of abnormal serum gastrin-17 than those in Nanjing did.

Conclusions:

The factors that differed between these two counties might indicate that residents in Minqing have a higher risk for developing gastric cancer than those in Nanjing do.     

Life-Threatening Angiomyxoma of the Larynx

Background

Angiomyxoma is a benign proliferative mesenchymal tumor and a very rare mass in the larynx. There is not enough information about the etiology, clinical finding, treatment and prognosis of laryngeal angiomyxoma.

Case Details

A 52 years old man presented with respiratory distress. Also, he had suffered from dysphagia, dysphonia, cough, and obstructive sleep apnea in the supine position for 6 months. He was operated on via transoral approach under general anesthesia with orotracheal intubation. The mass was encapsulated and completely removed. The histopathologic diagnosis was reported as angiomyxoma.

Conclusion

Angiomyxoma should be considered in the differential diagnosis of the larynx masses. The treatment of angiomyxomas of the larynx is surgical. The mass can be usually excised intraorally or endoscopically.     

Leiomyoma Arising from Mullerian Remnant,Mimicking Ovarian Tumor in a Woman with MRKH Syndrome and Unilateral Renal Agenesis

Background

Leiomyoma with secondary changes arising from Mullerian remnant may mimic ovarian tumor in women with Mayer-Rockitansky-Kuster-Hauser (MRKH) syndrome in patients with pelvic mass and urologic abnormalities.

Case Detail

The patient was a 40 years old known case of MRKH, presented with lower abdominal pain and swelling for over one year. On physical examination, large pelvic mass (about 15cm by 10cm) was found and a diagnosis of ovarian tumor was made by imaging which also showed absent right kidney. Finally, the mass was found to be a big leiomyoma with areas of hyaline, edematous and cystic degenerations.

Conclusion

Although leiomyoma arising from rudimentary Mullerian bulb is a rare condition, it should be considered in differential diagnosis of pelvic mass in patients with MRKH. Possibility of urologic abnormalities should also be considered in these patients and appropriate work up per local context should be made.     

Dietary Intakes,Obesity and Health Behaviors in Native Hawaiians Residing in Southern California

Objectives

Accessing dietary intakes, body mass index (BMI) and health behaviors in Native Hawaiians residing in Southern California.

Design

Cross-sectional, community based participatory research.

Participants

Native Hawaiian (N = 55); Mean age 59 (± 15).

Main Outcome Measures

Diet, body mass index (BMI), and diet/exercise health behaviors. Collected diet via 24-hr dietary recalls, health behaviors through questionnaires and BMI via measurement/self-report.

Analysis

Frequencies/means and multiple linear regression were used to assess diet, BMI, and health behaviors.

Results

Nearly 90% of the participants were either overweight or obese. Less than 20% met the vegetable, fruit, fiber, and whole grain recommendations. Most were a little or somewhat sure (relative to almost always sure) about their ability “to stick with an exercise program when attending a cultural gathering”, and “when visiting Hawai‘i”.

Conclusions and Implications

These results suggest that developing a culturally-based education program to reduce obesity and improve diet is critical for Native Hawaiians residing in Southern California.     

Relationship between patient safety and hospital surgical volume

Objective

To examine the relationship between hospital volume and in-hospital adverse events.

Data Sources

Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008.

Study Design

In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure.

Principal Findings

Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05).

Conclusion

These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events.     

Fate and complex pathogenic effects of dioxins and polychlorinated biphenyls in obese subjects before and after drastic weight loss

Background

In humans, persistent organic pollutants (POPs) are stored primarily in adipose tissue. Their total body burden and their contribution to obesity-associated diseases remain unclear.

Objectives

We characterized POP total body burden and their redistribution in obese individuals before and after drastic weight loss and compared these values with a variety of molecular, biological, and clinical parameters.

Methods

Seventy-one obese subjects were enrolled and underwent bariatric surgery. Blood and adipose tissue samples were obtained at different times from these individuals as well as from 18 lean women.

Results

POP content (17 dioxins/furans and 18 polychlorinated biphenyl congeners) in different adipose tissue territories was similar, allowing us to assess total POP body burden from a single biopsy. Total POP body burden was 2 to 3 times higher in obese than in lean individuals. We also found increased expression of some POP target genes in obese adipose tissue. Drastic weight loss led to increased serum POPs and, within 6–12 months, to a significant 15% decrease in total polychlorinated biphenyl body burden. Importantly, serum POP levels were positively correlated with liver toxicity markers and lipid parameters, independently of age and body mass index.

Conclusions

POP content in adipose tissue and serum correlate with biological markers of obesity-related dysfunctions. Drastic weight loss leads to a redistribution of POPs and to a moderate decrease of their total body burden.     

Subsite Distribution of Gastric Cancer in an Area of High Prevalence—Northwest Iran

Background

The aim of the present study was to determine subsites of gastric cancer in East Azerbaijan, Iran—a high incidence region for gastric cancer and Helicobacter pylori infection.

Methods

Data were collected from 2002 through 2007 from patients who sought treatment for gastrointestinal symptoms or signs at a university clinic and subsequently underwent upper gastrointestinal endoscopy.

Results

Cancer was diagnosed and histologically confirmed in 362 patients (352 adenocarcinomas). The mean age of the patients was 64.57 ± 11.32 (range, 16–94 years) and the male-to-female ratio was 2.8:1. The gastric cardia was involved in 40.3% of patients with gastric adenocarcinoma, while the gastric fundus was involved in 3.7%, the gastric body in 49.1%, and the gastric antrum in 24.1% of patients. Complete evaluation for metastasis was possible in 144 patients; 61 were free of metastasis, and most of these patients underwent surgical therapy. Cardia involvement was not associated with the sex or age of patients.

Conclusions

Noncardia gastric cancer is still more frequent in East Azerbaijan, which is likely due to the very high prevalence of infection with Helicobacter pylori. The low rate of cancer involving the fundus is a target for further research on the etiology of gastric cancer.Key words: gastric cancer, subsite, gastric cardia, Iran     

Blood pressure in relation to concentrations of PCB congeners and chlorinated pesticides

Background

Residents of Anniston, Alabama, live near a Monsanto plant that manufactured polychlorinated biphenyls (PCBs) from 1929 to 1971 and are relatively heavily exposed.

Objectives

The goal of this study was to determine the relationship, if any, between blood pressure and levels of total serum PCBs, several PCB groups with common actions or structure, 35 individual PCB congeners, and nine chlorinated pesticides.

Methods

Linear regression analysis was used to determine the relationships between blood pressure and serum levels of the various contaminants after adjustment for age, body mass index, sex, race, smoking, and exercise in 394 Anniston residents who were not taking antihypertensive medication.

Results

Other than age, total serum PCB concentration was the strongest determinant of blood pressure of the covariates studied. We found the strongest associations for those PCB congeners that had multiple ortho chlorines. We found the associations over the full range of blood pressure as well as in those subjects whose blood pressure was in the normal range. The chlorinated pesticides showed no consistent relationship to blood pressure.

Conclusions

In this cross-sectional study, serum concentrations of PCBs, especially those congeners with multiple ortho chlorines, were strongly associated with both systolic and diastolic blood pressure.     

Mean Sojourn Time of Preclinical Gastric Cancer in Korean Men: A Retrospective Observational Study

Objectives:

This retrospective cohort study aimed to estimate the mean sojourn time (MST) of preclinical gastric cancer in Korean men.

Methods:

The subjects consisted of voluntary male screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative at a baseline screening performed between January 2007 and December 2011. A new case was defined if gastric cancer cells were present in the biopsy specimens obtained from gastroscopy. The follow-up period was calculated as the number of person-years between the date of baseline screening gastroscopy and positive findings at a subsequent screening. The MST was calculated using transition rates of gastric cancer to determine the best screening interval.

Results:

Of the 171 979 voluntary male screenees, 61 688 (36%) underwent subsequent screening gastroscopies between January 2007 and December 2011. A total of 91 incident cases were found during 19 598 598 person-years of follow-up. The MST of gastric cancer was 2.37 years (95% confidence intervals, 1.92 to 2.96), and those aged 40 to 49 years had a shorter MST than those 50 to 69 years did.

Conclusions:

These findings support the 2-year interval of screening recommended by the nationwide gastric cancer screening program in Korea. Further studies for the age-specific MST among women are needed.     

Two Cases of Partial Hepatectomy for Malignant Melanoma

Background

While the liver is a frequent site of metastatic spread for malignant cutaneous as well as malignant ocular melanoma, isolated hepatic metastases without evidence of systemic disease is rare. Hepatic resection has been proposed as a therapeutic and potentially curative procedure in metastatic melanoma patients with isolated hepatic metastases.

Objective

To report two metastatic melanoma patients with isolated hepatic metastases treated with partial hepatectomy. In addition, the literature is reviewed and the management and efficacy of surgical excision for isolated hepatic disease in the setting of malignant melanoma is discussed.

Case Report

A 34-year-old woman with metastatic cutaneous melanoma and a 55-year-old man with metastatic ocular melanoma are presented. Both patients developed isolated hepatic metastases detected during routine surveillance following resection of their primary disease and underwent partial hepatectomy.

Conclusion

In select cases, partial hepatectomy is an efficacious and potentially curative treatment for metastatic melanoma patients with isolated hepatic metastases.     

Limitations and plausibility of the Pliocene lignite hypothesis in explaining the etiology of Balkan endemic nephropathy

Background:

Balkan endemic nephropathy (BEN) is a chronic, tubulointerstitial renal disease often accompanied by urothelial cancer that has a lethality of nearly 100%.

Introduction:

One of the many factors that have been proposed to play an etiological role in BEN is exposure to organic compounds from Pliocene lignite coal deposits via the drinking water in endemic areas.

Objectives:

The objective of this study was to systematically evaluate the role of the tenets of the Pliocene lignite hypothesis in the etiology of BEN in order to provide an improved understanding of the hypothesis for colleagues and patients alike.

Methods:

A comprehensive compilation of the possible limitations of the hypothesis, with each limitation addressed in turn is presented.

Results:

The Pliocene lignite hypothesis can best account for, is consistent with, or has the potential to explain the evidence associated with the myriad of factors related to BEN.

Conclusions:

Residents of endemic areas are exposed to complex mixtures containing hundreds of organic compounds at varying doses and their potentially more toxic (including nephrotoxic) and/or carcinogenic metabolites; however, a multifactorial etiology of BEN appears most likely.     

Congenital Epulis in a Newborn: A Case Report,Immunoprofiling and Review of Literature

Background

Congenital epulis is a rare lesion of the newborn, presenting as mass in the oral cavity which can interfere with respiration and feeding. It should be distinguished from other lesions which can occur in newborns, both clinically and histopathologically.

Case Details

Here, we report a case of congenital epulis in a newborn female on the right alveolar ridge, along with an extensive review of literature and discuss the immunoprofiling.

Conclusion

Early diagnosis of CE in a newborn is of paramount importance in the successful management of these rare cases.     

Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility

AIM:

to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility

METHOD:

longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed.

RESULTS:

The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035).

CONCLUSION:

the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.     

Salty Food Preference and Intake and Risk of Gastric Cancer: The JACC Study

Background

High sodium intake is a potential risk factor of gastric cancer. However, limited information is available on the relationship between salty food preference or intake and risk of gastric cancer. The aim of the present study was to determine the association between these variables among the Japanese population.

Methods

Between 1988 and 1990, 15 732 men and 24 997 women aged 40–79 years old with no history of cancer or cardiovascular disease completed a lifestyle questionnaire that included information about food intake. The subjects were enrolled in the Japan Collaborative Cohort (JACC) Study for Evaluation of Cancer Risk Sponsored by Monbusho. After a median follow-up of 14.3 years, 787 incident gastric cancers were documented. We examined the associations between salty food preference and intake and gastric cancer incidence using the Cox proportional hazard model.

Results

The risk of gastric cancer among subjects with a strong preference for salty food was approximately 30% higher than among those who preferred normal-level salty food (hazard ratio [HR] 1.31; 95% confidence interval [CI], 1.02–1.67). The risk of gastric cancer in subjects who consumed 3 and ≥4 bowls/day of miso soup was approximately 60% higher than in those who consumed less miso soup (HR 1.67; 95% CI, 1.16–2.39 and HR 1.64; 95% CI, 1.11–2.42, respectively). Sodium intake correlated positively and linearly with risk of gastric cancer (P for trend = 0.002).

Conclusions

The present study showed that salty food preference, consumption of large quantities of miso soup, and high sodium intake were associated with increased risk of gastric cancer among Japanese people.Key words: salt, gastric cancer, prospective study