The value of abdominal ultrasound in the diagnosis of colon cancer.

INTRODUCTION: Colon cancer is one of the main causes of cancer death. Diagnosis requires the examination of the entire large bowel by means of radiological or endoscopic techniques. Many patients suspect of colon cancer are referred for colonoscopy but nevertheless this suspicion is not confirmed after endoscopic examination. The objective of this study is the evaluation of the reliability of abdominal ultrasound in the diagnosis of these tumors. MATERIAL AND METHOD: We selected patients suspect of colon cancer referred to the endoscopy unit for a colonoscopy. An abdominal ultrasound was carried out on all patients prior to the endoscopy. Considering the endoscopic examination as a gold standard, the sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ultrasonography were evaluated. Likewise, a series of analytical and clinical parameters were evaluated, in an attempt to establish associated factors of a colon cancer. The statistical analysis was carried out by means of the statistical package SPSS 12.0 for Windows. RESULTS: 145 patients were included in the study (56.6% males) with an average 66.72 years of age (22-89). A cancer was diagnosed in 42 cases (28.9%). In the diagnosis of colon cancer, abdominal ultrasound presents a sensitivity of 79.06%, a specificity of 92.15%, a PPV and a NPV of 80.9% and of 91.2%, respectively. Excluding from the analysis lesions of the rectal ampulla, which cannot be adequately evaluated by means of ultrasound, the figures for sensitivity, specificity, PPV and NPV increase to 91.8, 92.1, 80.9 and 96.9% respectively. The univariate analysis showed that an age over 65 years and the presence of microcytosis are associated to a greater risk of colon cancer while after multivariate analysis only the presence of microcytosis resulted to be an independent predictive factor of cancer. CONCLUSIONS: Abdominal ultrasound presents high sensitivity, specificity, PPV and NPV in the diagnosis of colon cancer. The combination of an ultrasonography and a rectoscopy permits us to rule out the presence of a colorectal carcinoma. In patients with microcytosis of 65 years and over, if there is strong clinical suspicion, a negative ultrasound may not be sufficient to rule out a colorectal neoplasia.     

Family context assessment in a public health study

Objectives

To analyze the factorial structure of a new instrument to assess the quality of the family context (Etxadi-Gangoiti Scale) in a sample from the Gipuzkoa cohort of the Environment and Childhood (Infancia y Medio Ambiente [INMA]) study.

Methods

Families in a sample of 433 two-year-old children were assessed in a home visit with subsequent analysis of the factorial structure and psychometric properties of the data.

Results

An exploratory factorial analysis (principal axis factoring and varimax rotation) and a confirmatory factorial analysis were carried out; partial confirmation of the original factorial structure of the instrument was obtained, which revealed the following factorial structures. Subscale (1): promotion of cognitive and linguistic development, social skills, psychomotor skills, and pretend play and imitation; subscale (2): promotion of independence and self-esteem, provision of optimal frustration, social and emotional quality of the relationship, and absence of physical punishment; subscale (3): paternal involvement, low exposure to family conflict, low frequency of family conflict, relationship with the extended family, social support, diversity of experiences, low frequency of stressful events, and low parental perception of stress.

Discussion

The structure of the original instrument structure was partially confirmed, which was attributed to the characteristics of the sample. We stress the importance of the variability obtained in the evaluation of the families, as well as of adequate indicators of reliability in such evaluation. The new instrument could be used in public health to identify deficient family contexts and to design preventive interventions focused on parenting skills.     

Social Cognition in Chiari Malformation Type I: a Preliminary Characterization

Chiari malformation type I (CM-I) is a neurological disorder in which cerebellar tonsils are herniated through the foramen magnum into the spinal canal. A     

Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study

Background  

The objectives of this study were to determine the risk factors for relative adrenal insufficiency in cardiopulmonary bypass patients and the impact on postoperative vasopressor requirements.     

Mutación del gen BRAF V600E en el cáncer papilar de tiroides y su efecto en la terapia con yodo radiactivo (131I) posquirúrgica: ¿deberíamos modificar nuestra estrategia terapéutica?

Introduction

The BRAF V600E mutation in papillary thyroid cancer (PTC) has been associated with resistance to ¹³¹I. Our aim was to quantify the response to ¹³¹I after surgery in patients who had the mutation (BRAF+) and those who did not have the mutated gene (BRAF?).

Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial

Introduction

Extracorporeal circulation induces hemostatic alterations that lead to inflammatory response (IR) and postoperative bleeding. Tranexamic acid (TA) reduces fibrinolysis and blood loss after cardiopulmonary bypass (CPB). However, its effects on IR and vasoplegic shock (VS) are not well known and elucidating these effects was the main objective of this study.

Methods

A case control study was carried out to determine factors associated with IR after CPB. Patients undergoing elective CPB surgery were randomly assigned to receive 2 g of TA or placebo (0.9% saline) before and after intervention. We performed an intention-to-treat analysis, comparing the incidence of IR and VS. We also analyzed several biological parameters related to inflammation, coagulation, and fibrinolysis systems. We used SPSS version 12.2 for statistical purposes.

Results

In the case control study, 165 patients were studied, 20.6% fulfilled IR criteria, and the use of TA proved to be an independent protective variable (odds ratio 0.38, 95% confidence interval 0.18 to 0.81; P < 0.01). The clinical trial was interrupted. Fifty patients were randomly assigned to receive TA (24) or placebo (26). Incidence of IR was 17% in the TA group versus 42% in the placebo group (P = 0.047). In the TA group, we observed a significant reduction in the incidence of VS (P = 0.003), the use of norepinephrine (P = 0.029), and time on mechanical ventilation (P = 0.018). These patients showed significantly lower D-dimer, plasminogen activator inhibitor 1, and creatine-kinase levels and a trend toward lower levels of soluble tumor necrosis factor receptor and interleukin-6 within the first 24 hours after CPB.

Conclusion

The use of TA attenuates the development of IR and VS after CPB.

Trial registration number

ISRCTN05718824.     

No association between common Gly972Arg variant of the insulin receptor substrate-1 and polycystic ovary syndrome in Southern Chilean women

BACKGROUND: Previously studies have indicated that the insulin receptor substrate-1 (IRS-1) Gly972Arg (G972R) polymorphism is associated with polycystic ovary syndrome (PCOS). We examined the possible association between G972R common variant of the IRS-1 gene and PCOS in Southern Chilean women with PCOS and controls. METHODS: A total of 50 women with PCOS (29.1+/-8.1 yr) and 75 healthy women (29.3+/-9.3 yr) were included. Serum lipids, glucose and uric acid concentrations were determined by enzymatic-colorimetric methods. The G972R variant of the IRS-1 gene was detected by PCR-RFLP. RESULTS: Women with PCOS exhibited a higher concentrations of total testosterone, glucose, insulin, total cholesterol, triglycerides, LDL-C and uric acid, and lower HDL-C concentrations than controls (P<0.05). The presence of G972R polymorphism in PCOS and control women was not significantly different (16% vs. 6.6%, P=0.276). The OR for PCOS associated to 972R variant was 2.67 (95% CI: 0.82-8.69, P=NS). Moreover, neither association between G972R genotypes and metabolic parameters were observed in PCOS women or controls. CONCLUSION: Our data do not support an association between G972R variant of the IRS-1 with PCOS or its metabolic parameters in Southern Chilean women.