Radiologic versus endoscopic evaluation of the conduit after esophageal resection: a prospective,blinded, intraindividually controlled diagnostic study

Background

Anastomotic leakage is a major complication in esophageal surgery. Although contrast swallow is performed by many surgical centers before reintroduction of oral intake to exclude anastomotic leakage postoperatively, endoscopy is increasingly used in this situation and may be superior. This study compares radiographic contrast study and endoscopy for the identification of local complications after subtotal esophagectomy.

Methods

Between January 2006 and September 2007, a prospective, blinded, intraindividually controlled study was conducted in patients who underwent transthoracic esophagectomy due to esophageal cancer. A radiographic contrast study was performed prior to endoscopy on postoperative day 5–7. Technical feasibility, sensitivity, and specificity of the radiologic and endoscopic evaluations of the esophageal substitute were described.

Results

Radiographic contrast study was possible in only 64 % of the patients (35 of 55). The contrast study could not be performed in 20 patients due to contraindications or mechanical ventilation. Endoscopy could be performed in all patients (p < 0.001). Pathologic findings were detected in 13 patients by endoscopy but in only 1 patient by contrast swallow. Leakage of the anastomosis or the conduit was correctly detected in 7 patients by endoscopy but in only 1 patient by contrast swallow (p = 0.01). Endoscopy detected focal conduit necrosis or ischemia in six additional patients. Contrast studies showed false-positive results in two patients. Both sensitivity and specificity of endoscopy were 100 %, while sensitivity and specificity of the contrast study were only 20 and 94 %. No complications resulted from postoperative endoscopy or radiologic imaging.

Conclusions

Endoscopic evaluation of the esophageal substitute in the early postoperative course is possible in all patients without complications. Endoscopy is superior to the contrast study in detecting pathological findings after esophageal reconstruction. Radiologic contrast swallow in the early postoperative days is often not possible, has no further relevance, and should be replaced by endoscopic evaluation.     

Increased urinary nitric oxide oxidation products in children with active coeliac disease

BACKGROUND: Nitric oxide (NO) production catalyzed by iNOS (inducible NO synthase) is thought to take place mainly in macrophages after activation by inflammatory mediators. NO is subsequently oxidized to nitrite and nitrate, which are excreted in urine. The concentration of inflammatory mediators in small bowel biopsy specimens from patients with coeliac disease is increased. The latter could induce increased NO production by stimulation of intestinal macrophage iNOS, resulting in high levels of urinary NO oxidation products, nitrite and nitrate (NOx). AIM: In the present study we evaluated the urinary NOx/creatinine ratios in children with active coeliac disease (n = 22), coeliac disease patients on a gluten-free diet (n = 9), healthy (n = 11) and sick control children (n = 18). METHODS: The Griess reagent method was used for measuring urinary NOx. RESULTS: Median NOx/creatinine ratios of active coeliac disease patients, coeliac disease patients on a gluten-free diet, healthy and sick control patients were 1.21, 0.19, 0.10 and 0.13 mmol/mmol, respectively. All active coeliac disease patients showed increased NOx/ creatinine ratios. Urinary NOx/creatinine ratios of the active coeliac disease patients were significantly higher than those of healthy controls (p < 0.0001), sick controls (p < 0.0001) and coeliac disease patients on a gluten-free diet (p < 0.0001). CONCLUSION: The urinary NOx/creatinine ratio is increased in patients with active coeliac disease and reverts to normal on a gluten-free diet.     

大学生饮酒模式调查分析

目的分析影响大学生饮酒模式的因素,针对饮酒教育及酒精政策提出建议。方法采用整群抽样方法,选择来自北京和郑州的530名大学生完成有效问卷调查。采用 Epidata 录入数据,SAS 12.0和 R 2.7.2进行数据描述和分析。结果74.5%的大学生在过去1年内饮过酒,啤酒是饮酒者的主要选择（85.9%）,餐馆和家里是饮酒比较频繁的场所,饮用酒多来自同学/朋友及家庭成员提供,25.3%饮酒者并无特别原因饮酒,各有约1/5的饮酒者是出于社交目的或喜欢饮酒的感觉。认为“饮酒有助于社交暠或“饮酒促进交流暠者、父母及同学/朋友饮酒者、来自农村地区或小城镇者及吸烟者更容易发生饮酒行为（均 P 〈0.05）,男生大学生、规律饮酒者更容易遭遇强迫劝酒场面、更易发生醉酒（均 P 〈0.05）。超过一半饮酒者出现酒后脸红、肌肉软弱无力等生理反应,饮酒对被调查大学生产生的社会心理影响依次是记忆丧失（23.9%）、宿醉（14.6%）、做了后悔的事（低于10%）等。结论目前大学生仍保持着一种低风险饮酒模式。大学生饮酒教育应提供关于饮酒利弊的科学信息,使其对饮酒保持一种现实的期望。应制定针对性酒精政策和教育鼓励和支持低风险且满足社交功能的饮酒模式,控制高风险饮酒模式。     

The quality of life questionnaire EQ-5D-5L: psychometric properties and normative values for the general German population

Purpose

The health state classifier EQ-5D of the EuroQoL group has been expanded to a 5-level instrument (EQ-5D-5L), but studies on psychometric properties of this new instrument, applied to the general population, are rare.

Methods

A sample of 2,469 subjects, representatively selected from the German general population, was asked to fill in the EQ-5D-5L and several other questionnaires. Crude sum scores of the EQ-5D-5L were calculated and compared with scores derived from two sets of utilities, one from a German and one from a UK sample.

Results

The mean sum score (0–100 scale) was 91.5. Males reported better health states than females, and there was a nearly linear age trend. The list of the 45 most frequent health patterns (those with at least 0.2 % of the respondents) showed that almost half of the participants (47.5 %) responded being in the optimal health state, indicating a ceiling effect. Correlations between EQ-5D-5L scores and other questionnaires were very similar for all three scoring systems of the EQ-5D-5L. Finally, normative scores are given on the basis of sum scores.

Conclusions

The applicability of the EQ-5D-5L in the general population is limited because of the skewness. Sum scores are useful because of their simplicity, international generalizability, and construct validity.     

Gender-specific quality of life after cancer in young adulthood: a comparison with the general population

Purpose

Over the last years, adolescents and young adults with cancer (AYA) have moved strongly into scientific focus. However, there have only been a few studies about the quality of life of the AYA group, and gender differences have very rarely been examined.

Methods

A cross-sectional study was conducted with young adult cancer patients who were aged 18–39 years at the time of survey and had completed their acute treatment. We used the quality of life questionnaire European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). The EORTC QLQ-C30 contains five function scales (physical, role, emotional, cognitive and social), nine symptom scales and a global quality of life scale. The patient sample was compared to a gender- and age-matched representative sample (REP).

Results

Compared to the general population (N = 585), significantly poorer quality of life (p = .001) was observed for the 117 young cancer patients (40 male, 77 female) on all scales and items of the EORTC QLQ-C30. Analyses of variance with the factors group (AYA vs. REP) and gender showed interaction effects for the physical (p < .012), emotional (p < .029) and cognitive function scales (p < .008) and fatigue (p < .026) as well as for the items insomnia (p < .011), constipation (p < .037) and financial difficulties (p < .026). The pattern of the interaction was that female cancer patients reported the lowest quality of life outcomes. The same effects were found for the three calculated sum scales function, symptom and total.

Conclusions

Results clearly indicate that young adult cancer patients have a reduced quality of life in comparison with the general population even long after the treatment of their disease is complete. Women had a lower quality of life than men. Age-specific interventions should be offered that lead to improvements in quality of life for this age group. And future studies should clarify what factors lead to women’s quality of life being worse than men’s.     

Isolated and combined effects of prolonged exposures to noise and whole-body vibration on hearing,vision and strain

Summary This study was carried out in order: (1) to examine the effects of isolated and combined prolonged exposures to noise and whole-body vibration on hearing, vision and subjectively experienced strain, and (2) to check the combined effects with repeated exposures. Six male subjects were exposed twice to noise (N) at 92 dBA, whole-body vibration (V) in the Z-axis at 4 Hz and 1.0 ms^–2 rms, and noise and vibration (NV) for 90 min with each condition. Temporary threshold shifts of hearing (TTS) and their integrals (ITTS) were measured at 4, 6, 10, and 12 kHz. Visual acuity was examined by means of a very sensitive test. Cross-modality matching (CMM) of the handgrip force was used to judge the subjectively experienced strain. NV induced a clear tendency of higher TTS and ITTS than N, with several significant differences most pronounced at 10 kHz. With repeated exposures, the effect of NV decreased, while the reactions to N and V remained unchanged. The individual reactions to NV differed. The influence of the duration of exposures on vision depended on the condition; N caused time-dependent changes, whereas V did not. CMM-data increased with the duration of the exposure during V and NV. N was generally judged to be more straining than V; NV caused higher strain than V during the first 30 min of exposure only. Correlations between different effects suggest certain links between them. Additionally, less motivation — daily obtained by a questionnaire — often correlated with higher ITTS during N and NV. The results also illustrate the combined effects on the individual susceptibility, repetition of exposure, the kind of response, and, possibly, the actual psychic state.Abbreviations CMM cross-modality matching - MVC maximum voluntary contraction force - N exposure condition: noise level 92dBA, no whole-body vibration - NV exposure condition: combined exposure to noise with a level of 92 dBA and wholebody vibration with 4 Hz, 1 ms^–2 rms - V exposure condition: whole-body vibration with 4 Hz, 1 ms^–2 rms - TTS temporary threshold shift - ITTS integral of temporary threshold shift - WBV whole-body vibration in the common sense This work was done in the Temporary International Research Team on Combined Effects of Noise and Vibration of the Council of Mutual Economic Assistance of the Socialist Countries. The authors gratefully acknowledge the help and assistance of L.-M. Brumm, Y. Bening, M. Godau, G. Weber, and R. Vizcaino.     

基于雌激素浅谈逆针灸预防围绝经期女性高血压病的可行性

女性进入围绝经期后,随着雌激素分泌水平的下降,高血压病的患病率逐年升高。鉴于其不可治愈性,对"高血压前期"给予早期有效的干预,控制高血压病的发生发展,是当前预防围绝经期女性高血压病的有效措施。然而指南指出激素替代疗法和雌激素受体调节剂均不应用于围绝经期女性心血管疾病的预防,针灸作为一种既能同时调节血压和雌激素,又没有明显副作用的治疗方式,给围绝经期女性高血压病的预防带来了新的希望。文章通过探讨针灸、雌激素和高血压病三者的关系,阐释逆针灸预防围绝经期女性高血压病的可行性,为临床诊治提供参考。     

Der Wert des Einsatzes von Medien zur Patientenaufklärung und Motivation

Zusammenfassung Es wird der Zweck der Medien beschrieben, die im Wartezimmer, Sprechzimmer und im Elternhaus zum Einsatz kommen. Sie werden als Vermittler von Informationen verstanden, um das Verhalten der Patienten zu beeinflussen. Dabei haben die erforderliche Patientenmitarbeit bei der kieferorthopädischen Behandlung und das Bemühen um verbesserte Mundhygiene den gleichen Stellenwert. Die im Wartezimmer eingesetzten Medien können nur als Vorinformation gelten. Einen größeren Wert haben die Medien im Sprechzimmer, wie z. B. Anschauungsmodelle, Lehrtafeln oder ähnliches. Hier ausgegebene Merkblätter unterstützen verbale Erläuterungen zur Behandlung als Merkhilfe für den häuslichen Gebrauch. Kritisch wird festgestellt, daß ein lückenloses Mediensystem zur Aufklärung und Motivation für kieferorthopädische Behandlungen nach medienwissenschaftlichen Gesichtspunkten nicht existiert jedoch wünschenweert ist.

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Summary The purpose of the media available in the waiting room, consulting room and in patients' home is described. It acts as a transmitter of information aimed at influencing patient's behaviour. In doing so patient cooperation during orthodontic treatment and the endeavour for improved oral hygiene are of equal importance. Media available in the waiting room can only be considered as pre-information. Media in the consulting room have greater value, since demonstration models and educational posters are often present. It is also here where patient information leaflets support verbal instructions for review at home. It was critically ascertained that there is no complete media system which offers patient education and motivation for orthodontic treatment according to scientific standards. This would be highly desirable.

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Résumé L'auteur décrit l'action des médias qui dans les salles d'attente, les cabinets de consultation et à la maison ont la fonction d'influencer les patients par les informations qu'ils transmettent. La coopération nécessaire des patients pendant le traitement d'orthopédie dento-faciale et les efforts qu'on fait pour améliorer l'hygiène buccale ont la même importance. Les médias à disposition dans les salles d'attente ne constituent qu'une première information. Les médias utilisés dans les cabinets de consultation, tels que des modèles d'illustration, des tableaux d'enseignement etc. ont une valeur beaucoup plus grande. En distribuant des feuilles de renseignement comme aide-mémoire à la maison, on renforce l'effect des explications verbales. D'un point de vue critique, on constate qu'un système complet de médias, capable d'informer et de motiver le traitement d'orthopédie dento-faciale scientifiquement n'existe pas encore. mais qu'il est souhaitable.