Resection of the pancreas for acute hemorrhagic and necrotizing pancreatitis

The role of surgery in the treatment of acute hemorrhagic or necrotizing pancreatitis is discussed on the basis of a series of 996 patients with all types of acute pancreatitis who were treated in the years 1967–1976. Pancreatic resection was performed in 29 patients with hemorrhagic or necrotizing pancreatitis during the past 3 years. The extent of resection ranged from 60 to 100% of the pancreas. Eight patients died, for a mortality rate of 28%. Eight of 21 surviving patients developed diabetes requiring substitution therapy. During a follow-up period of 6 to 36 months, 17 patients were able to resume work, 3 are still convalescing, and 1 has retired.

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Résumé La place de la chirurgie dans le traitement de la pancréatite aiguë hémorragique ou nécrosante est discutée à partir de 996 cas de pancrèatites aiguës de tous types traités entre 1967 et 1976. Au cours des 3 dernières années, une pancréatectomie a été faite chez 29 malades atteints de pancréatite hémorragique ou nécrosante. L'étendue de la résection a été de 60 à 100%. Huit malades sont morts (28%). Parmi les 21 survivants, 8 ont développé un diabète exigeant une thérapeutique de substitution. Le follow-up est de 6 à 36 mois: 17 malades ont pu reprendre le travail; 3 sont encore en convalescence; le dernier a pris sa retraite.

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This work is supported by the Emil Aaltonen Foundation.     

Prenatal diagnosis of placenta accreta and percreta with ultrasonography, color Doppler, and magnetic resonance imaging

BACKGROUND: The risk of placenta previa and accreta is increased in females with previous cesarean deliveries, and there has been an increasing number of these operations. CASES: We present 2 cases with previous cesarean and placenta previa in the following pregnancy. One patient had placenta accreta and the other, placenta percreta. In both cases, prenatal diagnosis was based on ultrasonography, where features such as loss of the hypoechoic retroplacental zone and irregular uterine serosa were found in grayscale ultrasonography. In color Doppler imaging, in both cases, increased vascularity between myometrium and placenta, as well as intraplacental lacunae, were seen. Thinning of the uterine wall, found in magnetic resonance imaging, contributed to the diagnosis of placenta percreta. CONCLUSION: Prenatal diagnosis of placenta accreta is of importance because it reduces fetal and maternal morbidity as appropriate preoperative and perioperative procedures are possible.     

Spinal cord injury induces widespread chronic changes in cerebral white matter

Traumatic spinal cord injuries (SCIs) lead to axonal damage at the trauma site, as well as disconnections within the central nervous system. While the exact mechanisms of the long‐term pathophysiological consequences of SCIs are not fully understood, it is known that neuronal damage and degeneration are not limited to the direct proximity of the trauma. Instead, the effects can be detected even in the cerebrum. We examined SCI‐induced chronic brain changes with a case‐control design using 32 patients and 70 control subjects. Whole‐brain white matter (WM) tracts were assessed with diffusion tensor imaging (DTI). In addition, we analysed associations between DTI metrics and several clinical SCI variables. Whole‐brain analyses were executed by tract‐based spatial statistics (TBSS), with an additional complementary atlas‐based analysis (ABA). We observed widespread, statistically significant (P ≤ 0.01) changes similar to neural degeneration in SCI patients, both in the corticospinal tract (CST) and beyond. In addition, associations between DTI metrics and time since injury were found with TBSS and ABA, implying possible long‐term post‐injury neural regeneration. Using the ABA approach, we observed a correlation between SCI severity and DTI metrics, indicating a decrease in WM integrity along with patient sensory or motor scores. Our results suggest a widespread neurodegenerative effect of SCI within the cerebrum that is not limited to the motor pathways. Furthermore, DTI‐measured WM integrity of chronic SCI patients seemed to improve as time elapsed since injury. Hum Brain Mapp 38:3637–3647, 2017. © 2017 Wiley Periodicals, Inc.     

Has the adolescents' weight concern increased over 20 years?

BACKGROUND: The aim of this study is to evaluate whether the proportion of 12 to 18-year-old adolescents perceiving themselves to be overweight has increased from the late 1970s to the late 1990s, and to evaluate how self-reported weight is associated with weight concern in the different age groups among girls and boys, and how this association has changed over time. MATERIAL: A nationally representative sample of 26,700 girls and 23,346 boys, aged 12-18 years, who responded to the postal survey study Adolescent Health and Lifestyle Survey in 1979-1999. METHODS: Self-reported information about weight, height and satisfaction with one's own weight. RESULTS: Girls reported more concerns of being overweight than boys. The proportion of those perceiving themselves as being overweight decreased over time both among overweight and among normal weight adolescents. CONCLUSION: Even if the adolescent population has gained weight, they are less concerned at being overweight than earlier. It seems that adolescents compare themselves rather to the peers close to them than to ideal models provided by culture at large.     

Prognostication of astrocytoma patient survival by Ki-67 (MIB-1), PCNA,and S-phase fraction using archival paraffin-embedded samples

The prognostic power of three proliferation estimation methods, Ki-67 (MIB-1) and PCNA immunohistochemistry, and flow cytometry (S-phase and S+G2/M fractions, respectively), were evaluated in 50 cases of astrocytoma. Each proliferation index showed a strong association with the grade of malignancy (grades I-IV). The MIB-1 labelling index (LI) provided additional information, as it could be used for the discrimination of grade II and grade III astrocytomas (P=0·0357). All three proliferation estimation methods also had strong prognostic potential (MIB-1 LI: P<0·0001; PCNA Li: P<0·0001; S-phase: P=0·0004; S+G2/M: P=0·0124). According to the receiver operating characteristics (ROC) curve, the MIB-1 LI showed generally the best sensitivity and specificity in placing the patients correctly into groups of survivors and non-survivors, which was further confirmed in the multivariate analysis. Only 4 per cent of the patients having high MIB-1 scores (>15·3 per cent) were alive after 2-years' follow-up. In contrast, 72 per cent of patients with tumours of low proliferation activity survived. It appears that Ki-67 (MIB-1) immunolabelling using archival paraffin-embedded samples is of value in predicting prognosis in astrocytic tumours.     

Prognosis of non-specific musculoskeletal pain in preadolescents: a prospective 4-year follow-up study till adolescence

Musculoskeletal pain is common in children but studies on the outcome and predictive factors for persistence/recurrence of these symptoms are scarce. A baseline cross-sectional survey of 1756 schoolchildren (mean age 10.8) identified 564 (32.1%) children with musculoskeletal pain. At baseline, these children were evaluated using a structured questionnaire and examined for hypermobility and physical fitness. The children were re-evaluated after one year, and four years (at adolescence) using the same pain questionnaire. At 1-year follow-up, 53.8% (95% CI 48.8–58.8) of the children reported pain persistence (persistent preadolescent musculoskeletal pain). At 4-year follow-up, 63.5% (95% CI 58.7–68.1) of them had musculoskeletal pain. Neck was the site with most persistent/recurrent musculoskeletal pain. Those with persistent preadolescent musculoskeletal pain had approximately three times higher risk of pain recurrence (OR=2.90 [95% CI 1.9–4.4]). In the univariate analysis, female gender, older age group (11+), hypermobility, co-existence of psychosomatic symptoms, having high disability index, and reporting combined musculoskeletal pain at baseline predicted pain recurrence at adolescence. In the multivariate analysis, age, headache, hypermobility and having combined musculoskeletal pain were found as independent predictors. Statistically significant sex interactions were found for age, depressive feelings, waking up during nights and hypermobility. More psychosomatic symptoms predicted pain recurrence in girls than in boys, and hypermobility was a strong predictor in females only. Musculoskeletal pain in preadolescents is not a self-limiting phenomenon and more studies are still warranted to explore its determinants aiming to improve the long-term outcome of these symptoms.     

C-Reactive protein and erythrocyte sedimentation rate in differential diagnosis between infections and neoplastic fever in patients with solid tumours and lymphomas

The goals of our work were to study prospectively the possibility of differentiating between infections and neoplastic fever in adult cancer patients on admission, by means of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) or of follow-up CRP values. Patients and methods were as follows: the final infection group consisted of 56 patients and the noninfection group of 10 patients with neoplastic fever; CRP was measured on days 0, 3 and 5 and ESR at entry. The main results showed that the median CRP did not differ between the groups (91 mg/l vs 102 mg/l) on entry, while the ESR level was higher in the neoplastic fever group (50 mm/H vs 89 mm/H, P = 0.023). On admission, both markers had low area under receiver operating characteristic curves for the demonstration of infection (CRP 0.42; ESR 0.27). The CRP level dropped significantly in the infection group within 5 days (P = 0.009). We conclude that neither of the markers was useful in differentiating between infections and neoplastic fever on admission, but that the follow-up CRP values were advantageous in this respect.     

Primary care-based,targeted screening programme to promote sustained weight management

Objective. To identify overweight and obese subjects at increased cardiovascular risk in the community, and provide them with lifestyle counselling that is possible to implement in real life. Design. Longitudinal cohort study. Setting. The communities of Harjavalta and Kokemäki in south-western Finland. Subjects. A tape for measurement of waist and a risk factor questionnaire was mailed to home-dwelling inhabitants aged 45–70 years (n = 6013). Of the 4421 respondents, 2752 with at least one cardiovascular risk factor were examined by a public health nurse. For the subjects with high cardiovascular risk (n = 1950), an appointment with a physician was scheduled. The main goal of lifestyle counselling for the 1608 high-risk subjects with BMI ≥ 25 kg/m² was weight reduction of at least 5%. Among these, 906 had completed self-administrated questionnaires at baseline and form the present study population. Main outcome measure. Success in weight management. Results. At the three-year follow-up visit, 18% of subjects had lost ≥ 5% of their initial weight and 70% had stabilized their weight, while 12% had gained weight ≥ 5%. Newly diagnosed glucose disorder (OR 1.37 [95% CI 1.02–1.84]) predicted success in weight management, whereas depressive symptoms (OR 0.61 [95% CI 0.42–0.90]), excess alcohol use (OR 0.63 [95% CI 0.44–0.90]), and number of drugs used (OR 0.91 [95% CI 0.83–0.99]) at baseline predicted poor outcome. Conclusions. A primary care screening programme to identify overweight or obese individuals can promote sustained weight management. Psychological factors, especially depressive symptoms, are a critical component to consider before attempts to change the lifestyle of an individual.Key Words: Finland, general practice, lifestyle counselling, obesity, overweight, primary care, screening, weight managementIt is unknown whether a primary care-based obesity screening programme can promote long-term success in weight management.

• Using a targeted screening strategy together with low-intensity counselling, sustained weight management can be achieved in a primary care setting.
• Newly diagnosed glucose disorder seems to be an important motivating factor for weight loss.
• Of the participants with a weight gain of 5% or more during the follow-up, one in three had depressive symptoms at baseline.