Metabolic syndrome and colorectal cancer: the protective role of Mediterranean diet--a case-control study

The effect of Mediterranean diet on colorectal cancer, in the presence of the metabolic syndrome, was evaluated in 250 patients with first developed cancer (63 ± 12 years, 59% males) and 250 age-gender-matched controls. Adherence to the Mediterranean diet was evaluated with the modified-MedDietScore (theoretical range 0-75), while assessment of the metabolic syndrome (MetS) was based on the third Adult Treatment Panel ([ATP III] National Cholesterol Education Program) criteria. Presence of MetS (1.66, 95% confidence interval [CI] 1.02, 2.69), age (4.25, 95% CI 2.33, 7.77), smoking (1.85, 95% CI 1.27, 2.70), and family history of colorectal cancer (3.37, 95% CI 1.69, 6.75) had a detrimental effect, whereas adherence to the Mediterranean diet (0.88, 95% CI 0.84, 0.92) and body mass index (0.93, 95%CI 0.89, 0.98) had a protective role regarding colorectal cancer. Mediterranean diet had the same effect in relation to colorectal cancer, in both participants with (0.84, 95% CI 0.76, 0.93) and without MetS (0.89, 95% CI 0.85, 0.94).     

The long-term results of a two-stage protocol for revision of an infected total knee replacement

We report the long-term results of the management of neglected chronically infected total knee replacements with a two-stage re-implantation protocol. In 18 of 34 patients (53%) a resistant organism was isolated. All cases were treated by the same surgical team in a specialist centre and had a mean follow-up of 12.1 years (10 to 14). They were evaluated clinically and radiologically using the Knee Society Score (KSS) and the American Knee Society Roentgenographic scoring system, respectively. One patient died after eight years from an unrelated cause and two were lost to follow-up. Three patients (8.8%) developed a recurrent infection for which further surgery was required. The infection was eradicated successfully in 31 patients (91.1%). There was one case of aseptic loosening after 13 years. We found a significant improvement in the KSS at final follow-up (p < 0.001).     

Sildenafil may facilitate weaning in mechanically ventilated COPD patients: a report of three cases

We report three cases of mechanically ventilated chronic obstructive pulmonary disease patients who were intubated due to an exacerbation of their disease and who presented with repeated spontaneous breathing trial failures. Patients were given 50 mg of sildenafil through the nasogastric tube, under close monitoring of haemodynamic and ventilatory parameters. After sildenafil, pulmonary artery pressure, pulmonary artery occlusion pressure, the respiratory frequency to tidal volume ratio and the P(a)CO2-P(ET)CO2 (arterial minus end-tidal carbon dioxide pressure) decreased. Cardiac output increased in two of the patients, while all of them were successfully extubated. This is the first report of successful extubation after sildenafil use.