Endoscopic ultrasonography and computed tomography scanning for preoperative staging of colonic cancer

Purpose

With an increasing demand for more accurate preoperative staging methods for colon cancer, we aimed to compare preoperative tumour (T)- and nodal (N)-stage in patients with left-sided colon cancer by endoscopic ultrasonography (EUS) and computed tomography (CT) with post-operative histology as gold standard.

Methods

A total of 44 patients were prospectively recruited at Herlev and Roskilde University Hospitals during November 2014–January 2016. Thirty-five patients were included in the final analysis and underwent EUS, CT and surgery within 2 weeks. Diagnostic values were evaluated for “low risk” (T1+T2+T3 with ≤5 mm extramural invasion) and “high risk” (T3 with >5 mm of extramural spread + T4) colonic cancer.

Results

Sensitivity and specificity in “low risk” colonic cancer evaluated with EUS was 0.90 [0.74;0.98] and 0.75 [0.19;0.99] and with CT 0.96 [0.80;0.99] and 0.25 [<0.01;0.81]. EUS and CT were poor in predicting N0 or N+ disease.

Conclusions

The sensitivity of EUS and CT were good and comparable regarding T-stage evaluation, while EUS had a significantly higher specificity in the evaluation of “low risk” tumours. The results obtained for “high risk” colonic cancer were difficult to evaluate due to small patient numbers. EUS could be considered as a supplement to CT scans in selecting patients for neoadjuvant therapies, or local transmural treatment, in the future.

Trial registration

NCT02324023

     

Salmonella enteritidis orchitis in a 10–week-old boy

Extraintestinal manifestations of salmonellosis in paediatric patients are found predominantly in infants less than three months of age. Genital involvement is a rare complication. We present a short review of the literature and describe the case of a 10–week-old boy suffering from severe diarrhoea, who presented with a swelling of the right testicle after six days of illness. He underwent surgery on suspicion of testicular torsion, whereby orchitis was diagnosed. Salmonella enteritidis was cultured from the intraoperative swab. All cultures from blood, CSF and urine remained sterile. We conclude that orchitis must be taken into consideration as an extraintestinal complication of enteric salmonellosis and as a differential diagnosis of tcsticular torsion. In addition, we wish to emphasize that any infant less than three months of age with suspected or proven salmonellosis, should receive early antibiotic treatment.     

Postoperative pain treatment on wards – USA experience

A large variety of treatment options are now available to experienced pain therapists. Effective doses of opioids can be administered by the oral, rectal, transdermal, or sublingual route, or by subcutaneous, intramuscular, or intravenous injection or infusion. Patient–controlled analgesia (PCA) is now familiar and commonly available. Most PCA pumps also offer the option to add a continuous background infusion to the basic patinet–controlled mode with the possibility of therapeutic benefits and new problems. Alternative delivery routes and PCA drugs have been reported.
A variety of neural blockade techniques can provide effective and safe analgesia. These include topical application, local infiltration of incicions, and blockade of peripheral nerves or plexuses. Intrathecal and epidural opioids are now commonly used to control pain following a wide variety of surgical procedures, but many questions remain to be answered.
The concept of postoperative pain management by anesthesiologists is growing in popularity in North America. It is not surprising that such a revolutionaryidea involving basic changes in long–established practices is receiving attention not only from clinicians, but also from economists and politicians. One manifestation of this attention in the United States is a clinical practice guideline entitled Acute Pain Management: Operative or Medical Procedures and Trauma. Important elements of the guideline include recognition of historic inadequacies in postoperative pain management and acknowledgement of the importance of effective pain control.     

Renal excretion of endothelin in children is influenced by age and diuresis

Mattyus I, Zimmerhackl LB, Schwarz A, Hentschel M, Brandis M, Miltenyi M, Tulassay T. Renal excretion of endothelin in children is influenced by age and diuresis. Acta Pædiatr 1994;83:468–72. Stockholm. ISSN 0803–5253 Endothelin is a peptide with vasoactive and diuretic potential. Its release has been demonstrated from endothelial and renal epithelial cells. Urinary excretion of endothelin, as shown by others, is thought to reflect intrarenal production. We measured endothelin by RIA in a population of healthy children from Germany and Hungary (group 1), neonates (group 3) and children before and during forced diuresis (groups 2a and 2b). Group 1 consisted of 24 children living in Germany and 13 children resident in Hungary. The age range in this group was 2.9–17 years. Daily excretion correlated significantly with age (r= 0.48, p < 0.001), but endothelin excretion corrected for body surface area remained constant with regard to the age group studied. This indicates that body or kidney size may influence endothelin excretion, respectively. There was no difference in endothelin excretion between the two countries. In premature infants and neonates (group 3), daily excretion of endothelin was highest in infants with very low gestational ages and decreased in full-term neonates to values not significantly different to the group of older children. The high values in premature infants may have been influenced by mechanical ventilation of physical stress, which cannot be differentiated in this study, however. In contrast to reported results in adults, renal excretion of endothelin was correlated positively to urine flow in all groups. Furthermore, the influence of forced diuresis was evaluated in 10 children with oncological disease before (group 2a) and during (group 2b) forced diuresis with fluid load (3 l/m²; n= 4) and fluid load with furosemide injection (0.3–1.0 mg/kg body weight; n= 6). During this diuretic state, endothelin excretion was enhanced significantly.