Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

Background  

Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important.     

Implementation of Osteoporosis Screening Guidelines in Prostate Cancer Patients on Androgen Ablation

Androgen ablation (AA) therapy is one of the modalities used to treat prostate cancer. It is well known that AA therapy increases the risk of osteoporosis and fractures. In 2004, the British Columbia Cancer Agency published guidelines regarding bone health in these patients. A key recommendation was to arrange for bone mineral density (BMD) testing if AA was to be used for 6 mo or longer. Our objective was to evaluate how well these guidelines were implemented by reviewing the number of BMDs performed in patients who had been treated at one of the 4 cancer centers in British Columbia. We found that the overall number of BMDs documented after the implementation of the guidelines was significantly greater than the number documented before (25% vs 7.5%, p value < 0.0001). There appeared to be regional differences in implementation, with the greatest effect seen at the Vancouver center, which serves as the chief academic center for the province. The greater effect of guidelines at this center suggests a need for more effective dissemination peripherally. The care gap remaining at even the most impacted center indicates a need for greater efforts to both implement guidelines and monitor their implementation over time.     

Management of corticosteroid-induced osteoporosis

OBJECTIVES: To educate scientists and health care providers about the effects of corticosteroids on bone, and advise clinicians of the appropriate treatments for patients receiving corticosteroids. METHODS: This review summarizes the pathophysiology of corticosteroid-induced osteoporosis, describes the assessment methods used to evaluate this condition, examines the results of clinical trials of drugs, and explores a practical approach to the management of corticosteroid-induced osteoporosis based on data collected from published articles. RESULTS: Despite our lack of understanding about the biological mechanisms leading to corticosteroid-induced bone loss, effective therapy has been developed. Bisphosphonate therapy is beneficial in both the prevention and treatment of corticosteroid-induced osteoporosis. The data for the bisphosphonates are more compelling than for any other agent. For patients who have been treated but continue to lose bone, hormone replacement therapy, calcitonin, fluoride, or anabolic hormones should be considered. Calcium should be used only as an adjunctive therapy in the treatment or prevention of corticosteroid-induced bone loss and should be administered in combination with other agents. Conclusions: Bisphosphonates have shown significant treatment benefit and are the agents of choice for both the treatment and prevention of corticosteroid-induced osteoporosis.     

Effects of denosumab on bone histomorphometry: The FREEDOM and STAND studies

Denosumab, a human monoclonal antibody against RANKL, reversibly inhibits osteoclast‐mediated bone resorption and has been developed for use in osteoporosis. Its effects on bone histomorphometry have not been described previously. Iliac crest bone biopsies were collected at 24 and/or 36 months from osteoporotic postmenopausal women in the FREEDOM study (45 women receiving placebo and 47 denosumab) and at 12 months from postmenopausal women previously treated with alendronate in the STAND study (21 continuing alendronate and 15 changed to denosumab at trial entry). Qualitative histologic evaluation of biopsies was unremarkable. In the FREEDOM study, median eroded surface was reduced by more than 80% and osteoclasts were absent from more than 50% of biopsies in the denosumab group. Double labeling in trabecular bone was observed in 94% of placebo bones and in 19% of those treated with denosumab. Median bone‐formation rate was reduced by 97%. Among denosumab‐treated subjects, those with double labels and those with absent labels had similar levels of biochemical markers of bone turnover. In the STAND trial, indices of bone turnover tended to be lower in the denosumab group than in the alendronate group. Double labeling in trabecular bone was seen in 20% of the denosumab biopsies and in 90% of the alendronate samples. Denosumab markedly reduces bone turnover and also reduces fracture numbers. Longer follow‐up is necessary to determine how long such low turnover is safe. © 2010 American Society for Bone and Mineral Research.     

Combined Procedures with Laparoscopic Cholecystectomy

With advancement in laparoscopic surgery a number of surgical procedures can be performed combined with laparoscopic cholecystectomy in a single surgery. We evaluate the safety & efficacy of such surgeries. A retrospective review of all patients who had undergone combined procedures with laparoscopic cholecystectomy during January 2005 to June 2009 was performed. 3144 laparoscopic cholecystectomies were performed in the period from January 2005 to June 2009. Of these, 401 cases were combined with another procedure. The mean operative time was 80 min (range 50–270 min). The mean hospital stay was 3.2 days (range 1–5 days). The mean no. of days injectable analgesics was required was 2 days (range 1 day–4 days). Combined procedures provide patients with all the benefits of minimal invasive surgery and also give the benefit of single time anaesthesia without adding to post operative morbidity & hospital stay.     

Open liver resection for colorectal metastases: better short- and long-term outcomes in patients potentially suitable for laparoscopic liver resection

Background:

There is no prospective randomized data comparing laparoscopic to open hepatectomy. This study compared short- and long-term outcomes in patients undergoing hepatectomy for colorectal metastases (CRM), who were suitable for either laparoscopic or open surgery.

Methods:

Data were prospectively collected from consecutive patients undergoing hepatic resection of CRM at a single centre (1987–2007). Patients who were suitable for laparoscopic resection (Group 1) were compared with patients whose tumour characteristics would best be considered for open resection (Group 2).

Results:

Out of 1152 hepatectomies, 266 (23.1%) were deemed suitable for a laparoscopic approach. The median (IQR) number of metastases was greater in Group 2 [2(1–20) vs. 1(1–10), P < 0.001], as was the mean (SD) tumour size [5.3(3.6) cm vs. 3.3(1.2) cm, P < 0.001]. The median (IQR) operation time [210 (70) min vs. 240 (90) min, P < 0.001] and blood loss [270 (265) ml vs. 355 (320) ml, P < 0.001] were less in Group 1. There was no difference in length of stay, morbidity or mortality. Patients in Group 2 had a higher R1 resection rate (14.9%) compared with Group 1 (4.5%, P < 0.001) and lower 5-year survival (37.8% vs. 44.2%, P= 0.005).

Discussion:

Current criteria for laparoscopic hepatectomy selects patients who have more straight-forward surgery, with less risk of an involved resection margin and better long-term survival, compared with patients unsuited to a laparoscopic approach. Clearly defined criteria for laparoscopic hepatectomy are essential to allow meaningful analysis of outcomes and the results of unrandomized series of laparoscopic hepatectomies must be interpreted with caution.     

Early environmental influences contribute to covariation between internalizing symptoms and alcohol intoxication frequency across adolescence

The association between alcohol use and internalizing symptoms during adolescence varies across studies, and the causes underlying this association remain unclear. The current study examines the relationship between symptoms of anxiety and depression and intoxication frequency in a sample of Swedish twins assessed longitudinally from ages 13-14 to 19-20. The objectives of the study were to assess the stability of genetic and environmental influences on each trait across adolescence; to investigate whether these traits share genetic and/or environmental liabilities; and to explore quantitative changes in the shared liability over time. We found that the magnitude of genetic influences on internalizing symptoms remained relatively stable across adolescence, while their impact on intoxication frequency was dynamic. Symptoms of anxiety and depression were influenced by unique environmental factors, while both shared and unique environmental factors influenced intoxication frequency. Genetic and environmental innovation and attenuation were observed for both traits. While no significant genetic correlation was observed between traits, unique environmental factors did contribute to a shared liability. This environmental correlation was positive and moderate (r(E)=0.41) in the early assessment, but decreased and changed direction at later waves (r(E)=-.04 to -.01). The genetic and environmental factors underlying internalizing symptoms and intoxication frequency appear to be developmentally dynamic. Early environmental factors contribute to the association between these traits, but this shared liability diminishes across adolescence.