Stool DNA analysis detects premorphological colorectal neoplasia: a case report

We found, in an asymptomatic patient with familial occurrence of malignancy, that mutations in the oncogene Kras could be detected in stool 18 months before a premalignant polyp was detected and removed endoscopically. Colorectal cancers usually develop from benign adenomas in a lengthy period of 5-10 years. During this period, several major biochemical pathways are involved, each characterized by one or several genetic alterations. Our patient did not present any signs or symptoms of colorectal disease during his two visits to the endoscopist. This case report shows that the use of genetic markers in stool testing has the potential to detect colon cancer in its very early stages when treatment is simple and often successful.     

Resilience as a predictor of depressive symptoms: a correlational study with young adolescents

This correlational study explored the Resilience Scale for Adolescents (READ) as a predictor for developing depressive symptoms controlling for known risk factors. A young adolescent sample (N = 387) completed the READ, the Short Mood and Feeling Questionnaire (SMFQ), Social Phobia Anxiety Index for Children (SPAI-C), and the occurrence of Stressful Life Events (SLE). In addition, a subsample of their parents (N = 240) completed a parental version of READ (READ-P). The results indicated that the READ assesses important protective factors that are associated with fewer depressive symptoms among young adolescents even when controlling for known risk factors. All five READ-factors were predictors of depressive symptoms, while the READ-P showed no predictive value. There were no significant interaction effects between READ and SLE. There were, however, significant main-effects supporting a compensatory model of protective factors. The findings suggest that the READ is a significant predictor of mental health and a useful tool for further research examining differences in stress tolerance among young adolescents.     

A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia

The study's objective was to identify HPA 1a-negative women and to offer them an intervention program aimed to reduce morbidity and mortality of neonatal alloimmune thrombocytopenia (NAIT). HPA 1 typing was performed in 100 448 pregnant women. The HPA 1a-negative women were screened for anti-HPA 1a. In immunized women, delivery was performed by Cesarean section 2 to 4 weeks prior to term, with platelets from HPA 1a-negative donors reserved for immediate transfusion if petechiae were present and/or if platelet count was less than 35 x 10(9)/L. Of the women screened, 2.1% were HPA 1a negative, and anti-HPA 1a was detected in 10.6% of these. One hundred seventy pregnancies were managed according to the intervention program, resulting in 161 HPA 1a-positive children. Of these, 55 had severe thrombocytopenia (< 50 x 10(9)/L), including 2 with intracranial hemorrhage (ICH). One woman with a twin pregnancy missed the follow-up and had one stillborn and one severely thrombocytopenic live child. In 15 previous prospective studies (136 814 women) there were 51 cases of severe NAIT (3 intrauterine deaths and 7 with ICH). Acknowledging the limitation of comparing with historic controls, implementation of our screening and intervention program seemed to reduce the number of cases of severe NAIT-related complications from 10 of 51 to 3 of 57.     

Postoperative pain and self-management: women's experiences after cardiac surgery

Title.  Postoperative pain and self-management: women's experiences after cardiac surgery.
Aim.  This paper is a report of a study to describe women's experiences and their self-management of postoperative pain after elective cardiac surgery.
Background.  Cardiac surgery involves several pain-sensitive areas, and untreated postoperative pain may lead to chronic pain. Early discharge requires increased patient participation in pain management. Women report more postoperative pain than men after cardiac surgery.
Methods.  Semi-structured interviews were conducted in 2004–2005 with 10 women 1–2 weeks after discharge from their first elective cardiac surgery. Qualitative content analysis was used to identify recurring themes. Pain diaries were used to record postoperative pain experiences 1–2 weeks before the interviews, providing more nuances to the experiences of pain and pain management.
Findings.  Postoperative pain experiences varied from no pain to pain all the time. Worst pain intensity was recorded as moderate or more. Pain experiences depended on what women's expectations of pain after cardiac surgery. None wanted to complain about their painful experiences. The women had needed for more individualized information about self-management of pain, and had difficulties remembering the information they had received. Most did not want to use pain medication, or waited to do so until pain was unbearable.
Conclusion.  Patients need more individualized and gender-specific information before early discharge from cardiac surgery to improve self-management. More specific predischarge education on self-management using analgesics regularly might prevent pain ratings rising to a severe level after discharge home.     

Patient characteristics, operative complications and long-term survival of patients aged 75 years or older subjected to carotid endarterectomy.

AIM: The aim of this study is to report risk factors, operative results and long-term survival of old patients operated on for carotid stenosis in order to evaluate their candidature for surgery. METHODS: Fifty-two patients aged 75 years or older subjected to 56 carotid endarterectomies performed during the years 1992 to 2001 were examined and compared to data concerning 161 younger patients (172 operations) operated during the same period. RESULTS: Preoperatively registered hypertension, cardiac disease, renal impairment, diabetes mellitus, cerebrovascular symptoms and involvement of the contralateral carotid artery distributed similarly among the old and young patients. The older patients suffered an operative combined stroke and mortality rate non-significantly higher than the younger. The older patients experienced a 3-year survival rate of 92%. This was significantly superior to that of a demographically matched population, and similar to the survival of the younger patients. The younger patients had a survival rate significantly inferior to the expected. CONCLUSION: Patients aged 75 years or older operated on for carotid stenosis appear to have similar preoperative characteristics, similar early operative complication rates and a significantly better long-term relative survival, as compared to younger patients going through carotid endarterectomy.     

The Outcome of Occluded Above-knee Femoropopliteal Prostheses Implanted for Critical Ischaemia

OBJECTIVES: To investigate the impact of patient characteristics and treatment modality (graft thrombectomy vs thrombolysis) on the results of redo procedures for occluded above-knee prosthetic femoropopliteal grafts implanted for critical ischaemia. MATERIAL AND METHODS: Fifty-five procedures (thrombolysis 24 and thrombectomy 31) were performed on 24 prostheses (23 patients, 24 limbs) between January 1990 and December 2001. All cases were prospectively registered. Graft patency, limb salvage and survival rates were studied and subgroups of patients were compared. Risk factors were analysed with the use of log rank test and Cox proportional hazard analysis. RESULTS: Half of the 24 initial procedures to restored patency failed within one month. The outcome of second- or third-time redo procedures was similar. The primary patency rates of all 55 redo procedures were 32% at three months, 28% at six months and 12% at 12 months. The results of thrombectomy and thrombolysis were similar. Re-opened grafts additionally treated for an underlying anastomotic stenosis had significantly better patency as compared with re-opened grafts without a pre-existing stenosis on both univariate analysis (p = 0.024) and multivariate analysis (p = 0.027, hazard ratio 2.813). The one-year limb salvage rate was 76%. The one- and five-year survival rates were 87% and 52%, respectively. CONCLUSIONS: The results of redo procedures for occluded above-knee prosthetic grafts were disappointing. Grafts in which a graft-related stenosis was treated performed better than grafts in which occlusion could not be attributed to an underlying stenosis. Such cases should most likely be offered conservative treatment, amputation or a new arterial reconstruction.     

Inter-arch digital model vs. manual cast measurements: Accuracy and reliability

Objectives: The purpose of this study was to evaluate the accuracy and reliability of inter-arch measurements using digital dental models and conventional dental casts.

Methods: Thirty sets of dental casts with permanent dentition were examined. Manual measurements were done with a digital caliper directly on the dental casts, and digital measurements were made on 3D models by two independent examiners. Intra-class correlation coefficients (ICC), a paired sample t-test or Wilcoxon signed-rank test, and Bland–Altman plots were used to evaluate intra- and inter-examiner error and to determine the accuracy and reliability of the measurements.

Results: The ICC values were generally good for manual and excellent for digital measurements. The Bland–Altman plots of all the measurements showed good agreement between the manual and digital methods and excellent inter-examiner agreement using the digital method.

Conclusion: Inter-arch occlusal measurements on digital models are accurate and reliable and are superior to manual measurements.     

Effects on peritoneal proteolysis and hemodynamics of prophylactic and therapeutic infusions of high doses of aprotinin in experimental acute pancreatitis

Acute pancreatitis was induced in pigs by retrograde injection of Na-taurocholate into the pancreatic duct. Chromogenic peptide substrate assays showed increased trypsin (TRY) and plasma kallikrein activity (KK), parallel with a reduction of plasma prekallikrein (PKK) and functional kallikrein inhibition (KKI) values, in the peritoneal exudate in untreated animals. Intravenous high-dose pretreatment or therapy with aprotinin starting 3 h after the induction of acute pancreatitis resulted in significantly increased KKI capacity and unchanged KK and TRY activities in the peritoneal exudate. In test animals receiving aprotinin intravenously a significantly increased survival rate and improved cardiac output and arterial blood pressure were found during the 6-h observation period. All animals treated with aprotinin survived the observation period, whereas 63% of the untreated animals died. The study emphasizes the pathophysiological importance of the plasma kallikrein-kinin system in acute pancreatitis.