Ampullary carcinoma： Effect of preoperative biliary drainage on surgical outcome

AIM： To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma.
METHODS： We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage （PBD group）, and 47 were not drained （non-PBD group）. The mode of biliary drainage was endoscopic retrograde cholanoiopancreatography （n = 33） or percutaneous biliary drainage （n = 2）. The following parameters were analyzed： wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d （hospital mortality） and also longterm. The statistical endpoint of this study was patient survival after surgery.
RESULTS： The groups were well matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non- PBD group （10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group）.Of the parameters assessing postoperative morbidity, incidence of wound infection was significantly less in the PBD than the non-PBD group [1 （2.9%） vs 12 （25.5%）]. However, the rest of the parameters did not differ significantly between the groups, i.e. sepsis [10 （28.6%） vs 14 （29.8%）], intra-abdominal bleeding [1 （2.9%） vs 5 （10.6%）], intra-abdominal abscess [1 （2.9%） vs 8 （17%）], gastrointestinal bleeding [3 （8.6%） vs 5 （10.6%）], pancreatic leakage [2 （5.7%） vs 3 （6.4%）], biliary leakage [2 （5.7%） vs 3 （6.4%）], pancreatitis [2 （5.7%） vs 2 （4.3%）], gastroparesis [6 （17.1%） vs 10 （21.3%）], need for blood transfusion [10 （28.6%） vs 17 （36.2%）] and re-operation rate [1 （2.9%） vs 5 （10.6%）]. There was no early mortality in either group. Median survival was 44 mo （95% CI： 34.2-53.8） in the PBD group and 41 mo （95% CI： 27.7-54.3; P = 0.86） in the non-PBD group.
CONCLUSION： Biliary drainage before surgery for ampullary cancer significantly reduced postoperative wound infection. Overall mortality was not influenced by preoperative drainage.     

Relationship of family and personal history to the occurrence of depression in persons with Alzheimer's disease.

The authors tested the associations of family history and personal history of depression with mood disorders among patients with Alzheimer's disease (AD; N=161). Considered individually, a positive family history and a positive personal history each conferred increased risk for depression in AD. Conjointly, neither family nor personal history accounted for a substantial amount of the variance in syndromal depression after the onset of AD. Most depressed AD patients in this sample did not have a positive family history or a previous episode of depression. Our understanding of the etiology and course of depression and dementia may be augmented with further neuropsychological and brain-imaging studies of the neuropathological substrates shared by these illnesses.     

Project Dil: A Co-ordinated Primary Care and Community Health Promotion Programme for Reducing Risk Factors of Coronary Heart Disease Amongst the South Asian Community of Leicesterexperiences and evaluation of the project

Objectives To improve the effectiveness of primary and secondary prevention of coronary heart disease (CHD) in volunteer Leicestershire general practices with a high percentage of South Asian patients. To increase the awareness of lifestyle risk factors amongst the South Asian community with means of reducing CHD. Design Development and implementation of: A CHD training and awareness programme for health care professionals. Organizational change to ensure adoption of an effective secondary prevention programme for general practice. A public awareness campaign including a peer education programme for the South Asian community of Leicestershire. Interim evaluation using participation data, user satisfaction and organizational development of primary care is reported. Results A multi-disciplinary training programme accessed by 88% of staff from 23 volunteer practices has been developed and implemented. Organizational development in practices including CHD registers, action planning and establishing CHD clinics has taken place at a much faster pace than comparable non-Project Dil practices. An externally accredited peer education programme has been completed by 45 community volunteers. Within 6 months of completion, a total of 54 peer education sessions accessed by over 2,000 people from the Asian community had taken place. Project Dil, although initially funded only for 2 years, has now been adopted by Leicestershire Health Services (via a Primary Care Trust) as a mainstream programme. Conclusion Project Dil has made considerable progress in engaging and driving changes in general practices to facilitate improvement in CHD management. In parallel, the project has developed a community education programme, including the use of peer education. The project is now hosted by a Primary Care Trust on behalf of Leicester     

Ageing in Pakistan—A New Challenge

With increasing life spans across the world, Pakistan is also experiencing a rise in its elderly population. With meager resources and a poor understanding of aging; Pakistan faces many challenges in caring for its elderly population. This article highlights the present infrastructure and systems in place for the aged in Pakistan with a special focus on health and medical issues. Future possibilities for improvement in the health and wellbeing of our elderly are also discussed.     

Resistance to conventional insecticides in Pakistani populations of Musca domestica L. (Diptera: Muscidae): a potential ectoparasite of dairy animals

The house fly, Musca domestica L., is an important hygienic pest of humans and dairy animals with the potential to develop resistance to most chemical classes of insecticides. Six adult house fly strains from dairy farms in Punjab, Pakistan were evaluated for resistance to selected insecticides from organochlorine, organophosphate, carbamate and pyrethroid classes. For a chlorocyclodiene and two organophosphates tested, the resistance ratios (RR) at LC₅₀ were in the range of 5.60–22.02 fold for endosulfan, 7.66–23.24 fold for profenofos and 2.47–7.44 fold for chlorpyrifos. For two pyrethroids and one carbamate, the RR values at LC₅₀ were 30.22–70.02 for cypermethrin, 5.73–18.31 for deltamethrin, and 4.39–15.50 for methomyl. This is the first report of resistance to different classes of insecticides in Pakistani dairy populations of house flies. Regular insecticide resistance monitoring programs on dairy farms are needed to prevent field control failures. Moreover, integrated approaches including the judicious use of insecticides are needed to delay the development of insecticide resistance in house flies.     

Eastern Canadian Colorectal Cancer Consensus Conference: standards of care for the treatment of patients with rectal,pancreatic, and gastrointestinal stromal tumours and pancreatic neuroendocrine tumours

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Halifax, Nova Scotia, October 20–22, 2011. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of rectal cancer, including pathology reporting, neoadjuvant systemic and radiation therapy, surgical techniques, and palliative care of rectal cancer patients. Other topics discussed include multidisciplinary cancer conferences, treatment of gastrointestinal stromal tumours and pancreatic neuroendocrine tumours, the use of folfirinox in pancreatic cancer, and treatment of stage ii colon cancer.     

Genome-wide expression analysis of Middle Eastern colorectal cancer reveals FOXM1 as a novel target for cancer therapy

To identify genes potentially playing an important role in the progression of colorectal carcinoma (CRC), we screened global gene expression using cDNA expression array on 41 CRC tissue samples and 25 noncancerous colorectal tissue samples. Among the up-regulated genes, forkhead box M1 (FOXM1) has been shown to play a critical role in pathogenesis of various malignancies. Using immunohistochemistry on 448 Saudi CRC samples in tissue microarray format, FoxM1 protein overexpression was seen in 66% of CRC tissues and was significantly associated with poorly differentiated and highly proliferative tumors (P = 0.0200 and 0.0018, respectively). FoxM1 expression was also significantly associated with MMP-9 protein expression (P = 0.0002). In vitro data using CRC cell lines showed that inhibition of FoxM1 by thiostrepton resulted in inhibition of proliferation and induction of apoptosis in a dose-dependent manner. Overexpression of FoxM1 potentiated cell proliferation, cell transformation, and migration/invasion of CRC cells via up-regulation of FoxM1 target genes MMP2 and MMP9 and protected these cells from thiostrepton-mediated antiproliferative effects. Finally, in vivo, overexpression of FoxM1 promoted growth of CRC-cell line xenograft tumors in nude mice. Altogether, our data indicate that FoxM1 signaling contributes to aggressiveness in a subset of CRC and that the FOXM1 gene may serve as a useful molecular biomarker and potential therapeutic target.