Laparoscopic repair of incisional hernia in solid organ‐transplanted patients: the method of choice?

Due to immunosuppressive (IS) therapy, incisional hernias are overrepresented in the organ‐transplanted (Tx) population with larger defects, a high rate of recurrence, and a tendency toward more seromas and infectious problems. Thirty‐one Tx/IS patients with a control group of 70 non‐IS patients with incisional hernia (6/7 recurrences) were included in a prospective interventional study. Both cohorts were treated with laparoscopic ventral hernia repair (LVHR). Follow‐up time and rate was 37 months and 95%. One hundred LVHR's were completed as there was one conversion in the Tx/IS group. No late infections or mesh removals occurred. Recurrence rates were 9.7% vs. 4.2% (P = 0.37) and the overall complication rates were 19% vs. 27% (P = 0.80). The Tx/IS group had a higher mesh‐protrusion rate (29% vs. 13%, P = 0.09), but also larger hernias. Polycystic kidney disease was overrepresented in the Tx cohort (44% of kidney‐Tx). Incisional hernias in Tx/IS patients may be treated by LVHR with the same low complication rate and recurrence rate as non‐IS patients. By LVHR, the highly problematic seroma/infection problems encountered in Tx/IS patients treated by conventional open technique seem almost eliminated. The minimally invasive procedure seems particularly rational in the Tx/Is population and should be the method of choice. (ClinicalTrials.gov number: NCT00455299, date: 5 May 2006).     

Knowledge about social networks and integration: a co-operative research project

AIM: This paper is a report of a study investigating how knowledge of social network and integration influenced mental health professionals' understanding and practice. BACKGROUND: Community mental health work focuses on people suffering from mental health problems as well as the consequences for the person involved and their family or network. There is a need to expand community mental health workers' knowledge about social networks and their functions. METHOD: A qualitative study using a co-operative research approach was used to develop participants' knowledge of social network and social integration theory. Action research has the potential to facilitate changes in the field. Data were collected using focus groups. Qualitative content analysis was employed to develop the theme and categories. The data were collected in 2004-2005. FINDINGS: The main theme identified was the potential of experiential knowledge-based competence, which was characterized by the following categories: (1) increased knowledge, (2) awareness of social interactions, (3) cross-disciplinary professionalism and (4) potential for changes in practice. Participants' knowledge and awareness of the potential of social integration as a tool for social network interventions were considerably strengthened. However, this knowledge needs to be implemented in practice. CONCLUSION: Co-operative research is an approach that can be beneficial in the public sector. To achieve the best possible results, the whole team must be involved and play an active part in all areas of the research project. If the groups involved are too large, participants' level of engagement may suffer.     

Alcohol intoxication among cannabis users in a school-based adolescent sample

The aim of this study was to investigate whether alcohol intoxication is associated with cannabis use among Norwegian adolescents. The current study was based on a sub-set of data from the Norwegian Ungdata survey. A total of 28,953 adolescents from 33 municipalities responded to an illicit drug use module (response rate 77%). Results showed that a high frequency of alcohol intoxication in the past year was associated with use of cannabis as the sole illicit drug in the past year. The findings further reflected that a high frequency of alcohol intoxication in the past year was strongly associated with the frequency of cannabis use in the same period. Those who solely had used cannabis shared more characteristics with users of additional illicit drugs than with non-illicit drug users. Frequent alcohol intoxication seems to be associated with increased risk of frequent cannabis use. Early interventions could benefit from focussing on these drugs in tandem.     

Venous and neural invasion as predictors of recurrence in rectal adenocarcinoma

After radical surgery for rectal adenocarcinoma, the presence of venous and neural invasion of tumor cells was correlated with the pattern of treatment failure, local in the pelvis or distant. Of 128 operation specimens, venous and neural invasion was demonstrated in 22 percent and 32 percent, respectively. A significant decrease of the distant recurrence-free 5-year survival (Kaplan-Meier method) was seen when venous invasion was demonstrated (32.9 percent vs. 84.3 percent; P <0.0001), whereas more local failures were registered in patients with neural invasion. The local recurrence-free 5-year survival in patients with neural invasion was 64.3 percent, compared with 81.1 percent when neural invasion was not demonstrated (P=0.03). Their prognostic value was then studied in a Cox regression model including stage and grade. Neural invasion had the strongest association with local recurrences, whereas venous invasion was found to be the third strongest independent predictor of metastasis, after lymph node status and extent of local tumor infiltration. We conclude that examining for the presence of venous and neural invasion gives reliable prediction of recurrences after radical resection of rectal cancer. Recording of tumor recurrence pattern may lead to a better selection of patients for adjuvant therapy after surgery.     

AZGP1 and SPDEF mRNA expression differentiates breast carcinoma from ovarian serous carcinoma

The ANPEP, AZGP1, and SPDEF genes were previously found to be overexpressed in breast compared to ovarian carcinoma effusions. The present study validated this finding in a larger cohort consisting of both primary and metastatic tumors. ANPEP, AZGP1, and SPDEF mRNA expression was investigated in 83 breast carcinomas (57 primary carcinomas and 26 effusions) and 40 ovarian carcinomas (20 primary carcinomas and 20 effusions) using qPCR. ANPEP protein expression was immunohistochemically analyzed in 53 breast carcinoma effusions and patient-matched primary carcinomas (n?=?25) and lymph node metastases (n?=?16). mRNA and protein levels were studied for association with tumor type and anatomic site, and for clinical role in breast carcinoma. AZGP1 and SPDEF mRNA was overexpressed in breast compared to ovarian carcinoma (both p?<?0.001). AZGP1 mRNA was overexpressed in primary breast carcinoma compared to effusions (p?<?0.001), with opposite findings for ANPEP (p?=?0.044). AZGP1 mRNA expression correlated with positive ER status (p?=?0.032) and grade 1 histology (p?=?0.011), whereas SPDEF mRNA levels were associated with positive ER (p?=?0.002) and PR (p?=?0.013) status and tamoxifen treatment (p?=?0.004). ANPEP protein expression was higher in breast carcinoma effusions compared to primary tumors and lymph node metastases (both p?=?0.001). ANPEP, AZGP1, and SPDEF levels were unrelated to disease-free or overall survival. This is the first study documenting ANPEP, AZGP1, and SPDEF expression in breast carcinoma effusions. AZGP1 and SPDEF may be novel molecular markers for the differentiation of breast from ovarian carcinoma. ANPEP may be involved in breast carcinoma progression in view of its overexpression in effusions compared to solid specimens.