Leapfrog volume thresholds and perioperative complications after radical prostatectomy

BACKGROUND:

The authors explored the effect of Leapfrog volume thresholds (LVTs) on 5 short‐term radical prostatectomy (RP) outcomes.

METHODS:

Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), the authors focused on RPs performed within the 7 most contemporary years (2001‐2007). They tested rates of in‐hospital mortality, intraoperative complications, postoperative complications, and blood transfusions as well as the mean length of stay (LOS), stratified according to the number of LVTs that were met. Multivariable regression analyses were adjusted further for potential confounders.

RESULTS:

Overall, 36.2%, 17.3%, 14.9%, 15.7%, 12.9%, and 3% of RPs were performed at institutions that reached 0 LVT, 1 LVT, 2 LVTs, 3 LVTs, 4 LVTs, and 5 LVTs, respectively. Relative to patients who underwent RP at institutions that reached 0 LVTs, patients who underwent RP at institutions that reached 5 LVTs had fewer comorbidities, were younger, were more likely to hold private insurance, and were more likely to undergo concomitant pelvic lymphadenectomy (all P < .001). In multivariable analyses adjusted for hospital volume (HV), age, race, year of surgery, Charlson Comorbidity Index, hospital region and location, pelvic lymphadenectomy, and insurance status, LVT status was related inversely to LOS and the likelihood of receiving blood transfusions (both P < .001).

CONCLUSIONS:

The current results indicated that LVTs can provide a highly accurate prediction of the probability of 2 important, detrimental, short‐term outcomes after RP, even after accounting for HV. The benefit at institutions that meet LVTs may exceed that at other institutions when short‐term RP outcomes are considered. This observation should be taken into consideration when treatment decisions are made, especially because most RPs were performed at institutions that did not meet any LVTs. Cancer 2012. © 2012 American Cancer Society.     

Prevalence and clinicopathological characteristics of appendiceal carcinoids in Sharjah (United Arab Emirates)

AIM: To determine the incidence and clinico-pathological profile of appendiceal carcinoids in a cohort of patients undergoing emergency appendicectomies for clinically suspected acute appendicitis in Sharjah, United Arab Emirates (UAE). METHODS: The study included the retrospective data of 964 patients operated for clinically suspected acute appendicitis, and the resected specimens were received at Al-Qasmi Hospital (Sharjah) from January 2010 to December 2010. The data of the patients who were histologically reported to have carcinoid tumors of the appendix were extensively evaluated for the patient’s demographics, indication for surgery, surgical procedure, tumor localization in the appendix, diameter of the lesion, concomitant appendicitis, immunohistochemistry studies and clinical follow-up. RESULTS: Out of the 964 patients included in the study, 9 (0.93%) were found to have appendiceal carcinoids. The mean age reported was 28.7 years with a male to female ratio of 2:1. Eight tumors were located near the tip of the appendix with a mean diameter of 3.3 mm, while the remaining one was near the proximal end of the appendix. All the cases were associated with concomitant suppurative appendicitis. In seven reported cases, tumors were confined to the muscular layer while in one case each there was an extension to the serosa and mesoappendix, respectively. All tumors were found to be positive for chromogranin A, synaptophysin and neuron-specific enolase on immunohistochemistry but negative for cytokeratin-7. None of the patients developed recurrence or any reportable complications in the short follow-up period (12-26 mo) that was arranged as a six-monthly re-evaluation by abdominal ultrasonography. CONCLUSION: Our study found a higher incidence of appendiceal carcinoids in patients undergoing emergency appendectomy for acute appendicitis in Sharjah, UAE compared to two previous studies from the Persian Gulf region. Interestingly, tumors were found to be more commonly in young males, which is in contrast to previous studies. Moreover, all the tumors were positive for common neuroendocrine markers.     

Clinicopathologic evaluation of subgroups of diffuse large B cell lymphoma by immunohistochemistry

Diffuse large B cell lymphoma (DLBCL) has become an emerging epidemic in recent years. Striking heterogeneity in its clinical, biological and treatment responses prompted us to identify variation in our study group. The aim was to classify the DLBCL into prognosis-based subgroups according to the WHO classification and to evaluate their relation to clinical parameters (age, gender, anatomic location and B symptoms), as well as bcl 2 and Ki 67 status. Patients and Methods: A cross sectional study was carried out on 42 DLBCL patients, classified histologically and immunophenotypically into germinal center B cell like (GCB) or non-GCB type. Immunohistochemistry (IHC) was performed using antibodies against CD 10, MUM-1 and bcl 6; additionally anti-apoptotic protein bcl 2 and proliferative marker Ki 67 (using cutoff value of 70%) were also assayed by IHC. Results: Of the total 27/42 (64%) were males and 15/42 (36%) females, with a mean age of 44.1±15 years. 15/42 (36%) cases were of GCB type as compared to 27/42 (64%) of non GCB type. Extranodal involvement and B symptoms were seen in 18/27 (66.6%) and 20/27(74%) of the non GCB type, whereas bcl 2 protein expression and Ki 67 proliferative index (PI) <70% were each noted in 22/27 (81.4%). Conclusion: We document an astonishingly high number of non-GCB type DLBCL in our population. It is alarming to see such an aggressive tumor proliferating in our region. Significant association of non-GCB type with extranodal origin, B symptoms and low Ki 67 PI (<70%) is another concern.     

孟加拉吉大港区学龄前儿童眼病发生率研究

目的:研究吉大港区学龄前儿童的眼病发生率情况.方法:随机横断面抽样调查,研究孟加拉吉大港区学龄前儿童的眼病发生率.对60所托儿所4～6岁学龄前儿童进行记录,走访且检查眼睛.根据性别、年龄、视力障碍和眼部疾病的诱因,分析所获得的数据.结果:对60所托儿所共计900例学龄前儿童进行检查,其中男性儿童占52.6％,女性儿童占47.4％.年龄范围为4～6岁不等.平均年龄为5.47 ±0.64.在学龄前儿童中,眼病发生率为16.89％,通常疾病为7.66％儿童存在屈光不正,其次3.66％患结膜炎,2.77％患睑缘炎,1.66％患鼻泪管阻塞(NDO),0.88％患感染性结膜炎,0.33％患麦粒肿,0.44％患睑板腺囊肿.其中1.11％患弱视,0.77％患斜视,0.11％患发育性白内障,0.33％患角膜混浊,是一个值得关注的问题.结论:研究学龄前儿童的眼病发生率可以很容易地确定可持续视力筛查方案,如果及时采取治疗能够有效降低眼部疾病的患病率和视力障碍.目前的研究表明,未对屈光不正进行矫正是学龄前儿童视力障碍的主要原因.     

Inequity in psychiatric healthcare use in Australia

Background

Despite recent substantial mental healthcare reforms to increase the supply of healthcare, mental health inequality in Australia is rising. Understanding of the level of inequity (unmet need gap) in psychiatric service use in Australia’s mixed public–private health care system is lacking.

Objective

To present a novel method to measure inequity in the delivery of psychiatric care.

Methods

Data came from wave 9 (year 2009, n = 11,563) and wave 17 (year 2017, n = 16,194) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Multiple logistic regression was employed to estimate the psychiatric care utilisation compared to its need and the Gini index was used to estimate the standardised distribution of utilisation to measure the extent of inequity.

Results

The results show the inequity indices (need-standardised Gini) in psychiatric care utilisation were significant and found to be 0.066 and 0.096 in 2009 and 2017, respectively, for all individuals. In 2009, the inequity indices were found to be 0.051 and 0.078 for males and females, respectively, and 0.045 and 0.068 for rural and urban residents, respectively. In 2017, the indices were calculated to be 0.081 and 0.109 for males and females, respectively, and 0.086 and 0.097 for rural and urban residents, respectively.

Conclusions

This study showed a marked increase in unmet needs in psychiatric care utilisation since 2009. There is a greater need to develop policies to improve equity in psychiatric care utilisation in Australia.

     

Figurate erythema: an unusual presentation of the nonbullous phase of bullous pemphigoid

BACKGROUND AND OBJECTIVE: Bullous pemphigoid, an autoimmune disorder, most commonly presents as a bullous eruption in patients over the age of 60. There may be a prodromal urticarial or papular eruption that evolves to bullae. CONCLUSION:We report a 46-year-old woman with a figurate erythema presentation of bullous pemphigoid.     

Effective temporary analgesia for severe painful blind eye

There are various methods of providing pain relief for painful blind eyes. We wish to recommend this effective method of providing temporary analgesia in patients suffering from a severe painful blind eye before undergoing enucleation.