Laparoscopic Radical Cystectomy in the Elderly - Results of a Single Center LRC only Series

ABSTRACT Objective: To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly ( (≥75 years) versus 51 younger (<75 years) patients. patients. Materials and Methods: Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry. Results: Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 years). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median follow-up was 40.0 months for younger and 57.0 months for elderly patients. Estimated overall and cancer-specific survival at 5years. was 46% versus 35% and 64% versus 64% for younger and elderly patients respectively. Conclusions: Our results suggest that LRC is feasible in elderly patients, where a non-surgical treatment is usually favoured.

Nivel y cambio de la mortalidad vial en Argentina, Chile, Colombia y México, 2000-2011 / Level of and change in road traffic mortality in Argentina, Chile, Colombia and Mexico, 2000-2011

El objetivo de este trabajo es estimar el efecto de las muertes por atropellos y colisiones de tránsito en la esperanza de vida en Argentina, Chile, Colombia y México, entre 2000 y 2011. Se calcularon los años de esperanza de vida perdidos (AEVP) para los trienios 2000-2002 y 2009-2011. Los resultados indican que los decesos ocurridos por el tránsito representaron entre el 1% y el 4% del total para cada país. En el primer trienio, el mayor nivel de mortalidad ocurrió en Colombia (AEVP=0,96), mientras que el más bajo se registró en Argentina (AEVP=0,59). A excepción de este último país, hacia el segundo trienio, se redujo el impacto de estos fallecimientos sobre la esperanza de vida. El principal cambio tuvo lugar en Colombia que pasó a 0,72 AEVP. Se concluye que las muertes asociadas con el tránsito impactan de manera negativa en los sistemas de salud, las víctimas, el sector productivo y la sociedad en general. Desde esta perspectiva, la situación vial representa un problema de salud pública que requiere la intervención multisectorial en el diseño de políticas de alcance nacional y regional.

The aim of this study was to estimate the effect of run-over fatalities and traffic collisions in life expectancy in Argentina, Chile, Colombia and Mexico, between 2000 and 2011. Years of life expectancy lost (YLEL) were calculated for the periods 2000-2002 and 2009-2011. The results show that road traffic deaths made up between 1% and 4% of all deaths in each country. In the first period, the highest level of mortality occurred in Colombia (YLEL=0.96) and the lowest in Argentina (YLEL=0.59). In all the countries studied except Argentina, the impact of these deaths on life expectancy was reduced in the second period. The main change took place in Colombia, reaching 0.72 YLEL in the second period. It is concluded that traffic-related deaths have a negative impact on health systems, victims, the productive sector, and society in general. From this point of view, the issue of road transit must be considered a matter of public health, requiring multi-sector intervention in the design of national and regional policies.

Doença celíaca é super-representada em pacientes com constipação / Celiac disease is overrepresented in patients with constipation

OBJETIVO: Tem sido sugerido que pacientes com constipação sejam triados para doença celíaca. Da mesma forma, recomenda-se a investigação desses pacientes para hipotiroidismo e hipercalcemia. Contudo, nenhuma evidência para essas recomendações está disponível até o momento. Assim, propusemos-nos determinar a prevalência de doença celíaca, hipotiroidismo e hipercalcemia em crianças com constipação. MÉTODOS: Estudo de coorte prospectivo com 370 pacientes consecutivos que preencheram os critérios de Roma III para constipação. Esses pacientes foram encaminhados por um clínico geral a um pediatra devido ao fracasso no tratamento com laxantes. RESULTADOS: A biópsia comprovou doença celíaca em sete desses pacientes. Isso é significativamente mais alto (p < 0,001) do que a prevalência de 1:198 de doença celíaca nos Países Baixos. Dois pacientes tinham tiroidite autoimune. Nenhum paciente tinha hipercalcemia. CONCLUSÕES: Conclui-se que a doença celíaca é significativamente super-representada em pacientes com constipação encaminhados por um clínico geral a um pediatra devido ao fracasso no tratamento com laxantes. Todos esses pacientes devem, portanto, ser triados para doença celíaca.

OBJECTIVE: It is suggested that patients with constipation should be screened for celiac disease. Similarly, it is recommended to investigate these patients for hypothyroidism and hypercalcemia. However, no evidence for these recommendations is available so far. We therefore set out to determine the prevalence of celiac disease, hypothyroidism, and hypercalcemia in children with constipation. METHODS: Prospective cohort study of 370 consecutive patients who met the Rome III criteria for constipation. These patients were referred by a general practitioner to a pediatrician because of failure of laxative treatment. RESULTS: Seven of these patients had biopsy-proven celiac disease. This is significantly higher (p < 0.001) than the 1:198 prevalence of celiac disease in the Netherlands. Two patients had auto-immune thyroiditis. No patient had hypercalcemia. CONCLUSIONS: We conclude that celiac disease is significantly overrepresented in patients with constipation who are referred by a general practitioner to a pediatrician because of failure of laxative treatment. All such patients should, therefore, be screened for celiac disease.

Congenital toxoplasmosis and DALYs in the Netherlands

The calculation of disability-adjusted life years (DALYs) enables public health policy makers to compare the burden of disease of a specific disease with that of other (infectious) diseases. The incidence of a disease is important for the calculation of DALYs. To estimate the incidence of congenital toxoplasmosis (CT), a random sample of 10,008 dried blood spot filter paper cards from babies born in 2006 in the Netherlands were tested for Toxoplasma gondii-specific IgM antibodies. Eighteen samples were confirmed as positive for IgM, resulting in an observed birth incidence of CT of 1.8 cases per 1,000 live-born children in 2006 and an adjusted incidence of 2.0 cases per 1,000. This means that 388 infected children were born in 2006. The most likely burden of disease is estimated to be 2,300 DALYs (range 820-6,710 DALYs). In the previous calculations, using data from a regional study from 1987, this estimate was 620 DALYs (range 220-1,900 DALYs). The incidence of CT in the Netherlands is much higher than previously reported; it is 10 times higher than in Denmark and 20 times higher than in Ireland, based on estimates obtained using the same methods. There is no screening program in the Netherlands; most children will be born asymptomatic and therefore will not be detected or treated.