Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age

Background

A national surveillance program of colon cancer treatment was introduced in 2007. We examined prognostic factors for colon cancer operated in 2000 with an aim of improving survival in the new program and a special focus on the merit of lymph node yield.

Methods

A cohort of 269 patients, 152 women (56.5%), with a mean age of 71?years, was operated for colon cancer in 2000 at three teaching hospitals and followed up for 7?years.

Results

Overall 5-year survival was 58.0%, and overall hospital mortality was 5.2%, with 4.5% in elective cases and 12.5% after urgent surgery. In only 41.1% of the specimens were 12 or more lymph nodes retrieved, but this did not affect survival in the combined cohort, although one of the hospitals achieved a significantly better result with a harvest of 12 or more lymph nodes. In a multivariate analysis, old age, gender, a high lymph node ratio (LNR) at stage III, and tumor?Cnode?Cmetastasis stage were adverse factors for survival.

Conclusions

The operative mortality was high and should be reassessed. The lymph node count did not have a significant impact on outcome overall, whereas the LNR proved significant for stage III. A prospective protocol using overall lymph node yield as a surrogate measure for more radical surgery, nevertheless, seems warranted to improve the lymph node harvest according to international recommendations.     

Increased incidence of methicillin-resistant Staphylococcus aureus ST80, novel ST125 and SCCmecIV in the south-eastern part of Norway during a 12-year period

A retrospective population-based study of genotypes of methicillin-resistant Staphylococcus aureus (MRSA) was performed during the period 1991-2003 in two counties in the south-eastern part of Norway. Isolates of MRSA from all individuals in the two counties in whom MRSA was detected were genotyped by means of multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) typing, staphylococcal protein A gene (spa) typing and amplified fragment length polymorphism (AFLP) analysis. Until 1999, only sporadic cases of MRSA infection were reported in these counties, but the incidence increased during the following years. Nine new MLST types were identified in this study. The predominant strains were ST239-MRSA-III, the novel ST125-MRSA-IV, and the central European community-acquired strain ST80-MRSA-IV reported previously. ST80-MRSA-IV was introduced into the two counties in 1997, and the incidence of infections has increased since 2000, so that ST80-MRSA-IV is now the commonest MRSA strain in the region. An increase in MRSA clones carrying SCCmecIV has occurred during recent years, which could indicate a shift in the MRSA population in Norway from hospital-acquired MRSA to community-acquired-MRSA.     

Refinement of lymphoma cytogenetics by the chromosome 18q21 major breakpoint region

A small (2.8-kilobase, kb) major breakpoint region localized to segment 18q21 rearranges in greater than 70% of t(14;18)(q32;q21) lymphomas. This rearrangement interrupts the Bcl-2 gene and introduces it into the Ig locus at 14q32. The rearrangement between the joining region (JH) of Ig on chromosome 14 and the 18q21 region creates a translocation- specific DNA rearrangement. We generated probes that distinguish the 14;18 juncture on the derivative (der) 14 and der (18) chromosomes, providing a molecular approach to t(14;18) identification. Approximately 60% of unselected follicular lymphomas, 20% of diffuse large cell lymphomas, and 50% of adult undifferentiated non-Burkitt lymphomas demonstrated 14;18 rearrangements within the major breakpoint region. Examination of DNA for 14;18 rearrangements resolved the identity of 14q+ chromosomes in two patient's cells that lacked an obvious reciprocal partner. Identification of the exact restriction fragments that mediate translocations complements routine cytogenetics. The detection of DNA rearrangements does not require dividing cells or the presence of an identifiable reciprocal partner and can detect clonal translocation rearrangements when the neoplastic cells are only a minority of all cells present.     

Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II

Background

The aim of the present study was to investigate whether the new method of complete mesocolic excision (CME) with a high (apical) vascular tie (D3 resection) had an immediate effect compared with a conventional (standard) approach even in those patients without lymph node metastases.

Methods

A cohort of 189 consecutive patients with tumour–nodal–metastasis (TNM) stages I–II and a mean age of 73 years were operated on in the period from January 2007 to December 2008 in three community teaching hospitals. The CME approach (n = 89), used in hospital A, was compared to the standard technique used (n = 105) in two other hospitals, B and C. Lymph node yields from the specimens were used as a surrogate measure of radical resections. Outcome was analysed after a median follow-up of 50.2 months.

Results

In-hospital mortality rate was 2.8 % in the CME group and 8.6 % in the standard group. The 3-year overall survival (OS) in the CME group was 88.1 versus 79.0 % (p = 0.003) in the standard group, and the corresponding disease-free survival (DFS) was 82.1 versus 74.3 % (p = 0.026). Cancer-specific survival was 95.2 % in the CME group versus 90.5 % in the standard group (p = 0.067). Age, operative technique, and T category were significant in multiple Cox regressions of OS and DFS.

Conclusions

Compared with the standard (D2) approach, introduction of CME surgical management of colon cancer resulted in a significant immediate improvement of 3-year survival for patients with TNM stage I–II tumours as assessed by OS and DFS.     

Expression of Campylobacter jejuni invasiveness in cell cultures coinfected with other bacteria.

Enteroinvasive Salmonella, Shigella, and Escherichia coli strains were found to exert an effect which rendered Campylobacter jejuni capable of intracellular localization in epithelial cells in vitro. When monolayers of HEp-2 or A-549 cells were challenged with pure cultures of C. jejuni or Campylobacter coli, none of the eight strains tested invaded the cells. In contrast, four of these strains were able to localize intracellularly when the cells were challenged with a mixture of campylobacters and enteroinvasive Salmonella typhimurium, Shigella flexneri, Shigella boydii, Shigella sonnei, or E. coli strains. Invasiveness of campylobacters was also induced by one nonenteroinvasive strain of E. coli O124. Coinfection with other nonenteroinvasive E. coli strains did not induce invasiveness in C. jejuni. The degree of internalization induced by S. typhimurium was significantly higher than that induced by Shigella or E. coli strains. The invasive capacity of C. jejuni was found to differ considerably between strains. No evidence of an invasive potential was demonstrable for two C. coli strains or for two enterotoxigenic isolates of C. jejuni examined. C. jejuni was only able to localize intracellularly in cell cultures when the interaction occurred in a microaerobic atmosphere. None of the strains tested evoked keratoconjunctivitis in guinea pig eyes (Sereny test), regardless of the presence of coinfectants. The results indicate that a synergistic interaction that exists between C. jejuni and other enteropathogens facilitates invasion by C. jejuni.     

Nasal carriage of Staphylococcus aureus: which sequence types do orthopedic surgical healthcare workers carry?

Using sequence typing methods, we found that healthcare workers on our orthopedic surgery unit were persistent carriers of a limited number of sequence types of Staphylococcus aureus for a limited time. Multilocus sequence typing characterized 3 clonal complexes that accounted for more than 80% of the clonal complexes identified.     

Compensation claims after hip arthroplasty surgery in Norway 2008–2018

Background and purpose — Orthopedic surgery is one of the specialties with most compensation claims, therefore we assessed the most common reasons for complaints following total hip arthroplasty (THA) reported to the Norwegian System of Patient Injury Compensation (NPE) and viewed these complaints in light of the data from the Norwegian Arthroplasty Register (NAR).Patients and methods — We collected data from NPE and NAR for the study period (2008–2018), including age, sex, and type of complaint, and reason for accepted claims from NPE, and the number of arthroplasty surgeries from NAR. The institutions were grouped by quartiles into quarters according to annual procedure volume, and the effect of hospital procedure volume on the risk for accepted claim was estimated.Results — 70,327 THAs were reported to NAR. NPE handled 1,350 claims, corresponding to 1.9% of all reported THAs. 595 (44%) claims were accepted, representing 0.8% of all THAs. Hospital-acquired infection was the most common reason for accepted claims (34%), followed by wrong implant position in 11% of patients. Low annual volume institutions (less than 93 THAs per year) had a statistically significant 1.6 times higher proportion of accepted claims compared with higher volume institutions.Interpretation — The 0.8% risk of accepted claims following THAs is 1.6 times higher for patients treated in low-volume institutions, which should consider increasing the volume of THAs or referring these patients to higher volume institutions.

In Norway, compensation claims are handled by the Norwegian System of Patient Injury Compensation (NPE) and not by the judiciary system. If a patient in Norway suffers a complication due to a treatment error, within either the public or private healthcare sector, the patient can file a free-of-charge compensation claim to NPE. For claims to be accepted, 3 criteria must be met. 1st, the injury must have occurred during medical treatment (examination, diagnosis, or treatment/lack of treatment) or during follow-up, and the treatment must be deemed substandard or erroneous based on current treatment guidelines. 2nd, the injury must have led to financial loss (currently set at €1,000) or to a persistent medical impairment of minimum 15%. Lastly, the claim must be filed within 3 years after the patient became aware that the injury was likely a treatment error. There is 1 exception clause to these criteria: If the injury is rare and severe, claims may be accepted even when no treatment error has been identified. The amount of compensation is being reviewed on an individual basis and calculated to cover the patient’s loss of income and increased medical expenses due to the treatment injury.Orthopedic surgery is one of the specialties with most compensation claims following medical treatment (Jena et al. 2011). Previous studies on compensation claims after THAs have been limited by methodological inadequacies, such as short study period or limited sample size with claims ranging from 40 to just above 300 (Bhutta et al. 2011, Bokshan et al. 2017, Novi et al. 2020). We evaluated claims following both primary and revision THAs filed at the NPE from 2008 to 2018 and compared these findings with data from NAR, with a focus on institutional procedure volume.     

Rapid detection of cytomegalovirus infection in immunocompromised patients

Several routinely employed diagnostic methods were analysed for their usefulness in aiding an early and rapid diagnosis of human cytomegalovirus infection in immunocompromised patients. Clinical samples obtained during an 18-month period were examined by conventional culture, the shell vial method, detection of pp65 antigen and the polymerase chain reaction. Detection of pp65 antigen in peripheral leukocytes was the most useful method for rapid detection of infection at an early stage. Results of other rapid detection methods, the shell vial method and the polymerase chain reaction, gave useful support, while results obtained by conventional culture were not available until after the initiation of therapy. Only a small proportion of serological tests provided useful information for determining whether to treat the patient.