Screening of first degree relatives of patients operated for colorectal cancer: evaluation of fecal calprotectin vs. hemoccult II.

UNLABELLED: Fecal calprotectin (CPT) is elevated in the majority of patients with known colorectal cancer (CRC), but the specificity is not clarified. AIM: To evaluate if a CPT test (PhiCal ELISA) was more sensitive than Hemoccult II test in detecting colorectal neoplasia, and to obtain reference values in subjects with normal colonoscopy. To evaluate a possible relation between number and extent of dysplasia of adenomas in first degree relatives of patients with CRC and the stage of the carcinoma in the index casus. Further to study the prevalence of CRC and adenomas in the first degree relatives of patients operated for CRC. METHOD: In a multicenter study, 253 first degree relatives of patients with CRC, aged 50-75 years (mean age 60 years) underwent colonoscopy after having delivered stool samples and three Hemoccult II slides. RESULTS: In 237 first degree relatives from 148 patients with CRC, polyps were found in 118 (50%). Seventy three (31%) had adenomas and 17 had adenomas > or =10 mm. Five had asymptomatic cancers. The specificity of fecal CPT for adenomas at cut off levels 15 mg/l. The sensitivity of Hemoccult II for adenomas was 8%, and 4/5 of patients with carcinoma had negative Hemoccult II. The specificity for adenomas was 95%. CONCLUSION: Fecal CPT test was more sensitive than Hemoccult II in detecting colorectal neoplasia but the specificity was lower. In a high risk group like first degree relatives of patients with CRC, there are good reasons to consider fecal CPT as a first test in selecting patients for endoscopy.

[Infection at the wheel]. / Smitte på hjul.

PIP: The project Truckstop started in 1989 in Tanzania, and Mamma Chuma or Anna Oladia was among the first people to enlist. She has a bar and a guest house for long-haul truck drivers where she provides information and stocks supplies of condoms for them. The African Medical and Research Foundation was responsible for the project. Seven truckstops were established and 25 instructors, including Mamma Chuma, became involved. Most instructors are bar owners, and the others are service women. A senior health behavior officer at AMREF recounts that truck drives were known to a major source of infection; they were heeding neither local education campaigns nor information from the radio. Bar owners and other instructors were educated about how HIV infects and how to communicate this fact while convincing the truck drivers to use condoms. Theater and songs also communicate the message. Every month the instructors also send reports to AMREF. The project was evaluated in the fall of 1992 and it showed that condom use had increased from 50% to 91% among women and from 54% to 74% among drivers. Especially the older drivers were skeptical about using condoms, but they changed their minds during the 3-year period. There are more of them who do not run to prostitutes or who seek information and condoms. Prostitutes continue to consent to intercourse without condoms albeit at double the price. The choice between the risk of a deadly disease and an extra 300 shillings is often difficult when money is sorely needed.^ieng

[AIDS in Tanzania]. / AIDS i Tanzania.

PIP: The World Health Organization has announced that within 3 years 10% of Tanzania's population of 26 million will be infected with the human immunodeficiency virus (HIV). But there is some faint hope in the research of Tanzanian traditional medicine. An almost 90-year-man, Waziri Mrisho, is credited with having treated AIDS patients successfully with herbs that strengthen the immune system. Margaret Nakamya was stricken by the symptoms of AIDs in March 1990. She was referred to Waziri and started using his herbs. 3 years later she weighs 49 kg compared to 40 kg before. The old man's son set up a little factory where he pulverizes herbs and sells them at the price he can command The 3 types of trees that the herbal medicine is taken from grow in the wild, but some have also been planted around the factory. Even if these herbs are effective, it will take years before the AIDS epidemic is over, when people have changed their lifestyles. The means of communication (TV, cinema, radio, telephone) are missing or inadequate. In the Kagera region, with 1.2 million inhabitants, 25% of pregnant women are HIV-infected and 65,000 children lost their parents to AIDS. There are 2000 children in Dar Es Salaam living in the streets. The Anglican St. Albans Church runs a center for street kids where they get meals 3 times a week. The nurse Ruth Nesje enlisted a Norwegian physician and homeopath in a research project involving 30 AIDS patients in Norway. The University in Bergen will do in vitro testing. One group of patients will receive both AZT and the herbs, another group will get only AZT, and the 3rd group will obtain only the herbs. The Norwegian Nursing Association, NORAD, and DANIDA also plan various projects in the Tanga region.^ieng