Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months.

PURPOSE: To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU). METHODS: Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared. RESULTS: Patients in Cohort B1 were significantly more likely to have received chemotherapy (p < 0.001), radiotherapy (p < 0.05), and reported poorer QoL (p = 0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p < 0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first year CONCLUSIONS: PTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs.

Surgical repair of a tibial fracture in a two-week-old grey seal (Halichoerus grypus).

OBJECTIVE: To report the successful management of a suspected infected tibial fracture in a common grey seal. STUDY DESIGN: Case report. ANIMAL: Female common grey seal (Halichoerus grypus), 2 weeks old, 20 kg. METHODS: A closed, complete, transverse fracture of the left tibial distal diaphysis was debrided, reduced and stabilized using a string-of-pearls (SOP) locking plate covered with polymethylmethacrylate impregnated with gentamicin. Fracture of the ipsilateral fibula was left untreated. Postoperative radiographs were obtained immediately, and at 10 days, three weeks, and six weeks post-surgery, and a computed tomographic examination was performed 2.5 months post- surgery. A species-specific progressive rehabilitation programme was conducted. RESULTS: Bone healing of both fractures and absence of injury of the distal tibial growth plate were evident on the 2.5 month follow-up examination, and also full range-of-motion of the flipper was preserved and no lameness or difficulty with swimming and hunting were detected. On computed tomography, signs of chronic left coxofemoral and ilial wing trauma were incidentally detected. The seal was released three months postoperatively. CONCLUSION: A transverse infected distal fracture of the tibia and fibula in a young common grey seal was successfully managed with the combination of single SOP plating of the tibia, local antibiotic release and a specific rehabilitation programme. CLINICAL RELEVANCE: Surgical treatment of a long-bone fracture in a wild immature grey seal was successful with a combination of techniques adapted to the species.

The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature.

BACKGROUND: Evidence for the role of diet and physical activity in cancer incidence is well documented, but owing to increased cancer survivorship, an understanding of these lifestyle factors after a cancer diagnosis is of crucial importance. The purpose of this review was to update the literature in a review undertaken for the National Cancer Survivorship Initiative and to include observational studies that were not included in the WCRF survivorship systematic review. METHODS: Evidence was initially gathered from pre-defined searches of the Cochrane Library Database and PubMed from March 2006 to February 2010. After a comprehensive review regarding lifestyle and cancer, for the purpose of this article, any studies not related to diet and physical activity, prognostic outcomes, and breast, colorectal or prostate cancers were excluded. Another search of 2011 literature was conducted to update the evidence. RESULTS: A total of 43 records were included in this review. Evidence from observational studies suggests that a low-fat, high-fibre diet might be protective against cancer recurrence and progression. However, there is a paucity of RCTs substantiating this. There is more support for physical activity, with a dose response for better outcomes. When synthesized with findings from the World Cancer Research Fund review of RCTs investigating the effect of diet and physical activity interventions on cancer survival, evidence suggests that the mechanism of benefit from diet and physical activity pertains to body weight, with excess body weight being a risk factor, which is modifiable through lifestyle. IMPLICATIONS: Cancer survivors would like to have a more active role in their health care and to know how to look after themselves after diagnosis, including what diet and lifestyle changes they should make. The challenge is in integrating lifestyle support into standardised models of aftercare.

Treatment of primary CLL cells with bezafibrate and medroxyprogesterone acetate induces apoptosis and represses the pro-proliferative signal of CD40-ligand, in part through increased 15dDelta12,14,PGJ2.

B-cell chronic lymphocytic leukemia (CLL), the most common leukemia in older adults, remains largely incurable and novel treatments are urgently required. We previously reported powerful pro-apoptotic actions of bezafibrate (BEZ) and medroxyprogesterone acetate (MPA) against Burkitts lymphoma cells. Here, we demonstrate that BEZ and MPA individually, and more potently when combined (BEZ+MPA), induce apoptosis of unsorted and CD19(+ve)-selected CLL cells and abrogate the pro-proliferative activity of CD40(L). This action was tumor cell specific, as the drugs had little impact on normal donor cells. The antiproliferative actions of BEZ+MPA were associated with the generation of reactive oxygen species (ROS), and the proapoptotic actions were associated with the generation of both ROS and mitochondrial superoxide (MSO). BEZ increased prostaglandin D(2) (PGD(2)) synthesis by CLL cells, and treatment with PGD(2) and its antineoplastic derivative 15dDelta(12,14,)PGJ(2) recapitulated BEZ-induced antiproliferative and proapoptotic actions. The PGD(2) receptor antagonist, BW868C, did not block BEZ or PGD(2) activity against CLL cells. The potency of BEZ+MPA against CLL cells mirrored that of chlorambucil, and BEZ+MPA combined with chlorambucil was more potent than either treatment alone. Given the known safety profiles of BEZ and MPA, our data warrant further investigation of their potential as novel therapy for CLL.

Haemosuccus pancreaticus: treatment by arterial embolization.

AIM: Haemosuccus pancreaticus is bleeding into the pancreatic duct from a peripancreatic artery. This condition most commonly follows pseudoaneurysm formation secondary to acute or chronic pancreatitis. It is a rare disorder, challenging in both diagnosis and therapy. We present an eight-year experience of managing these patients using endovascular embolization as the primary therapy. MATERIALS AND METHODS: We retrospectively reviewed the imaging, laboratory results and clinical notes of the five patients who presented to this institution between 1991-1999 with gastrointestinal bleeding subsequently found to be haemosuccus pancreaticus. RESULTS: There were four men and one women aged 38-75 years. All had a history of gastrointestinal haemorrhage and had acute (n=1) or chronic pancreatitis with a complicating pseudoaneurysm. All underwent embolization as the primary therapy for the pseudoaneurysm. There was immediate technical success in all cases without major complication. No patient required operative surgery for the pseudoaneurysm. Follow-up ranged from 18 months to 7 years. One patient died four years after embolization due to hepatic failure but the other four remain well without further gastrointestinal bleeding. CONCLUSION: Endovascular embolization is an effective and safe treatment for haemosuccus pancreaticus.

Elective caesarean section--the patient's choice?

It has traditionally been considered inappropriate for women to have an elective caesarean section on request in an uncomplicated pregnancy. In previous studies, female obstetricians and midwives have been questioned on their preferred mode of delivery. This study asked 344 women attending a routine antenatal booking clinic what mode of delivery they would prefer in an uncomplicated pregnancy and why. Of the women questioned, 14.5% opted for an elective caesarean section at 39 weeks' gestation. The main reasons being to avoid maternal trauma, to avoid a prolonged labour and for fetal wellbeing. A caesarean section may have some potential benefits over a vaginal delivery and it is hard to refuse a well-informed woman an elective caesarean section on request, even if it results in a further rise in the rate of caesarean section.

Heritability estimates for psychotic disorders: the Maudsley twin psychosis series.

BACKGROUND: Previous twin studies have supported a genetic contribution to the major categories of psychotic disorders, but few of these have employed operational diagnostic criteria, and no such study has been based on a sample that included the full range of functional psychotic disorders. METHODS: A total of 224 twin probands (106 monozygotic, 118 dizygotic) with a same-sex co-twin and a lifetime history of psychosis was ascertained from the service-based Maudsley Twin Register in London, England. Research Diagnostic Criteria psychotic diagnoses were made on a lifetime-ever basis. Main-lifetime diagnoses of DSM-III-R and International Statistical Classification of Diseases, 10th Revision schizophrenia were also made. Probandwise concordance rates and correlations in liability were calculated, and biometrical model fitting applied. RESULTS: A substantial genetic contribution to variance in liability was confirmed for the major diagnostic categories except Research Diagnostic Criteria depressive psychosis and unspecified functional psychosis, where familial transmission was confirmed, but the relative contribution of genetic and common environmental factors was unclear. Heritability estimates for Research Diagnostic Criteria schizophrenia, schizoaffective disorder, mania, DSM-III-R schizophrenia, and International Statistical Classification of Diseases, 10th Revision schizophrenia were all between 82% and 85%. None of the estimates differed significantly from any other. CONCLUSIONS: Heritability estimates for schizophrenia, schizoaffective disorder, and mania were substantial and similar. Population morbid risk estimates were inferred rather than directly measured, but the results were very similar to those from studies where morbid risks were directly estimated.

A population study of face and brow presentation.

This was a retrospective review of the experience of face and brow presentation deliveries in South Glamorgan between 1990 and 1996. The incidence of face and brow presentation was 1 in 994 and 1 in 755 deliveries respectively (no cases of cranial vault anomalies in this series). There was a higher incidence of prematurity and very low birthweight among infants delivered by face presentation and higher incidence of postmaturity among those delivered by brow when compared with the vertex population in the same period. Over half of malpresentations were diagnosed in the second stage. Most fetuses presenting by the brow were delivered by caesarean section and 56% of fetuses presenting by face presentation achieved a vaginal delivery. The reported incidence of these forms of deflexed cephalic attitudes has gradually changed over the last century especially over the past decade when the incidence of face is no longer more common than brow presentation.

Giardiasis in native marsupials of Tasmania.

Tasmanian native marsupials were screened for the presence of Giardia spp. over a 3 yr period, revealing a 21% prevalence in the 295 animals tested. A pilot study of experimentally infected eastern barred bandicoots (Perameles gunnii) indicated susceptibility to infection with Giardia duodenalis from a human source.

Comparison of the family history with the family study method: report from the Camberwell Collaborative Psychosis Study.

We assessed the accuracy of the family history (FH-RDC) and family study (SADS-L) methods for obtaining information about the presence of psychopathology in 274 first-degree relatives of patients with psychotic disorders. The family history method had only modest sensitivity, 40.8% for affective disorders and 58.6% for psychotic disorders, but high specificity, 94.1% for affective disorders and 98.7% for psychotic disorders. For both disorders, sensitivity was higher for relatives who had had previous psychiatric admissions. However, with the family study method, we found that relatives with affective disorder were more likely to be interviewed than those relatives with other disorders. Hence, the family study method may be prone to selection bias that distorts morbid risk estimates. We conclude that the best way of collecting information regarding family psychopathology is to interview directly as many relatives as possible and to collect supplementary family history information on unavailable relatives.

Spontaneous resolution of non-immune hydrops fetalis secondary to transplacental parvovirus B19 infection.

We report a case of hydrops fetalis secondary to transplacental parvovirus B19 infection, in which spontaneous resolution of the hydrops occurred 4 weeks after the initial presentation. This case emphasizes the role of conservative management based on ultrasound evidence of continued resolution of the hydrops and intrauterine growth retardation.