Effects of a pre-visit online information tool about genetic counselling for ovarian cancer patients, a randomized controlled trial.

OBJECTIVE: In the Netherlands, patients with ovarian cancer are offered genetic testing. Pre-test preparation may help counseling patients. The aim of this study was to determine if use of a web-based intervention, leads to more effective genetic counseling of ovarian cancer patients. METHODS: Between 2016 and 2018, 127 ovarian cancer patients referred for genetic counseling in our hospital participated in this trial. 104 Patients were analyzed. All patients filled out questionnaires pre- and post-counseling. The intervention group also completed a questionnaire after visiting an online tool. Length of consultation, patients' satisfaction, knowledge, anxiety, depression and distress were compared before and after counselling. RESULTS: The intervention group had the same level of knowledge compared to the counseling group, but at an earlier point in time. They were satisfied with the intervention (86%) and better prepared for counseling (66%). The intervention did not lead to shorter consultations. No differences in levels of anxiety, depression, distress and satisfaction were observed. CONCLUSION: Although consultation length was unaffected, the improvements in knowledge after online education and patients satisfaction indicates that this tool can be an effective addition to genetic counseling. PRACTICE IMPLICATIONS: Use of an educational tool may lead to a more effective, personalized way of genetic counselling and enables shared decision making.

Bowel habits in the first 24 months of life: preterm- versus term-born infants.

BACKGROUND AND AIM: New prospective studies concerning feeding and bowel habits of term and preterm infants from birth to 24 months of life are needed. The aim of the present study was to describe and compare feeding and bowel habits between term- and preterm-born infants starting from birth up to the age of 24 months. PATIENTS AND METHODS: Between August and November 2006 all of the infants admitted to an academic and nonacademic neonatal care unit with gestational age 25 to 42 weeks participated in the study. Bowel diaries were recorded 1 and 2 weeks, and 3, 6, 12, and 24 months after birth. Infants with gastrointestinal surgery, neurological diseases, metabolic diseases, or congenital abnormalities were excluded. RESULTS: A total of 199 (126 preterm) infants were eligible; 153 gave consent for participation. Although feeding frequency was higher in the first 3 months in the preterm born, overall feeding frequency decreased between the first 3 follow-up periods (P < 0.001) in both groups. In the first and second week, breast-fed infants had 2.41 more episodes of defecation per week compared with the formula-fed infants (P = 0.017 and P = 0.021, respectively). Higher median (10th percentile-90th percentile) defecation frequency was only found in week 1 in the term compared with the preterm group (24 [9.4-31.6] versus 16 [6.5-31]; P = 0.002). The overall median defecation frequency was 16 (7-30) per week from birth up to the age of 24 months over the total group of participating infants. CONCLUSIONS: Term and preterm infants have a comparable defecation frequency from the second week of life up to the age of 24 months.

Duration of meconium passage in preterm and term infants.

BACKGROUND: First passage of stool after birth, meconium, is delayed in preterm infants compared to term infants. The difference in duration of meconium passage until transition to normal stools has however never been assessed in preterm and term infants. HYPOTHESIS: Preterm infants have prolonged duration of passage of meconium (PoM) compared to term infants. METHODS: Between August and November 2006, all infants born in an academic and non-academic hospital with gestational age (GA) 25-42 weeks and without metabolical, congenital diseases or gastrointestinal disorders, were included. Infants were divided into four groups: (A) GA < or =30 weeks; (B) GA between 31 and 34 weeks; (C) GA between 35 and 36 weeks; (D) GA > or = 37 weeks (term born). RESULTS: A total of 198 infants (102 males); 32, 62, 33 and 71 infants in groups A, B, C and D, respectively, were included. With decreasing gestation a trend was found for delayed first PoM (p<0.001). Compared to term infants 79% (56/71), less preterm infants passed their first stool within 24 h after birth--group A: 44% (14/32); group B: 68% (42/62); and group C: 73% (24/33). With decreasing gestation a trend for prolonged PoM was found (p<0.001). The mean (SD) PoM duration was prolonged in group A: 7.8 days (2.5); group B: 4.3 days (2.4); and group C: 2.9 days (1.3) compared to term infants. Furthermore, PoM was associated with birth weights < or =2500 g (p = 0.03) and morphine therapy (p = 0.03). Duration of PoM was not associated with type of feeding, small for gestational age, large for gestational age or need for respiratory support. CONCLUSION: PoM was not only delayed but also prolonged in preterm infants. Duration of PoM was associated with GA, birth weight and morphine therapy.

Digital radiography with a large-scale electronic flat-panel detector vs. screen-film radiography: observer preference in clinical skeletal diagnostics.

The imaging performance of a recently developed digital flat-panel detector system was compared with conventional screen-film imaging in an observer preference study. In total, 34 image pairs of various regions of the skeleton were obtained in 24 patients; 30 image pairs were included in the study. The conventional images were acquired with 250- and 400-speed screen-film combinations, using the standard technique of our department. Within hours, the digital images were obtained using identical exposure parameters. The digital system employed a large-area (43x43 cm) flat-panel detector based on amorphous silicon (Trixell Pixium 4600), integrated in a Bucky table. Six radiologists independently evaluated the image pairs with respect to image latitude, soft tissue rendition, rendition of the periosteal and enosteal border of cortical bone, rendition of cancellous bone and the visibility of potentially present pathological changes, using a subjective five-point scale. The digital images were rated significantly (p=0.001) better than the screen-film images with respect to soft tissue rendition and image latitude. Also the rendition of the cancellous bone and the periosteal and enosteal border of the cortical bone was rated significantly (p=0.05) better for the flat-panel detector. The visibility of pathological lesions was equivalent; only large-area sclerotic lesions (n=2) were seen superiorly on screen-film images. The new digital flat-panel detector based on amorphous silicon appears to be at least equivalent to conventional screen-film combinations for skeletal examinations, and in most respects even superior.

Central nervous system relapse in non-Hodgkin lymphoma. A single-center study of 532 patients.

OBJECTIVES: To define the cumulative risk of central nervous system (CNS) relapse in systemic non-Hodgkin lymphoma (NHL); to assess the risk factors of age, sex, malignancy grade, stage, localization, and response to initial therapy; and to evaluate the effect of CNS prophylaxis. PATIENTS AND METHODS: An unselected group of 532 patients with systemic NHL. A retrospective analysis. RESULTS: Eleven patients presented with systemic as well as CNS localization, whereas in 55 patients, CNS relapse occurred later. The cumulative risk of CNS relapse at 4 years for all 532 patients was 19%. High-grade NHL carried a 39% risk of CNS relapse, with the vast majority of relapses occurring in the first 14 months after the initial diagnosis. The cumulative risk in patients with intermediate-grade NHL was considerable (22%) and dispersed throughout a much longer period (6 years). Patients with low-grade NHL still carried a 7% risk of CNS relapse; in all these patients, low malignancy grade was transformed into a higher malignancy grade at that time. In a multivariate analysis, high- and intermediate-grade NHL and advanced stage were independent risk factors for CNS relapse. There was not any strong evidence for a beneficial role of CNS prophylaxis in patients with intermediate- and high-grade NHL, but a retrospective analysis cannot be conclusive with regard to the effect of therapy. Systemic relapse occurred rapidly after CNS relapse, resulting in a median survival time after CNS relapse of only 2 months. CONCLUSIONS: Patients with high- and intermediate-grade NHL carry a considerable risk of CNS relapse. Advanced stage is an additional independent risk factor. The role of CNS prophylaxis seems to be disappointing, but a retrospective analysis cannot be conclusive. Prognosis after CNS relapse is poor.

[Receptivity of the endometrium: comparison of ultrasound and histologic findings after hormonal stimulation]. / Zur Rezeptivität des Endometriums: Vergleich sonographischer und histologischer Befunde nach hormoneller Stimulation.

On the day of the scheduled embryo transfer, endometrial biopsies were taken from 53 patients of an IVF-programme. There was subsequent failure of fertilisation in all of these patients. The histologic pattern, compared with reflectivity and thickness of the endometrium was determined sonographically on the same day. All patients had been stimulated with hMG/hCG, and the ovaries and the endometrium had been monitored by transvaginal sonography. The reflectivity pattern was divided into grades (A to D according to Smith et al., 1984) and related to histological findings. The distribution of the grades was as follows: 16 patients (30%) grade A, 22 patients (42%) grade B, and 15 patients (28%) grade C. There was no case of grade D in our study. The results of histologic examination for grades A to C were not significantly different from each other. However, in only 37% of grade A, 63% of grade B and 66% of grade C, the endometrial response corresponded to the state of the cycle. Endometrial thickness for the receptive and non-receptive groups was not significantly different (8.8 +/- 0.29 mm vs. 9.13 +/- 0.4 mm). The results show no correlation between histologic findings and endometrial thickness or reflectivity. We therefore conclude, that sonographic determination of these parameters is not helpful in the evaluation of the degree of endometrial response.

Fentanyl in 2% mepivacaine compared with fentanyl in 0.5% bupivacaine: two parallel controlled double blind studies.

The efficacy of epidural mepivacaine and bupivacaine, combined with fentanyl to enhance blockade, was compared in two parallel controlled, double-blind clinical trials. Patients in the studies (n = 91) were scheduled for orthopedic surgery of the legs and a tourniquet was used in all cases. Those patients receiving mepivacaine attended day surgery only, whereas patients receiving bupivacaine were hospitalised. Epidural puncture was performed with a Tuohy needle at the L3-4 level in the lateral decubitus position. Levels of sensory and motor blockade were assessed; adverse reactions and pain during surgery were recorded. There were four groups of patients: 1) 26 received 2% mepivacaine with placebo; 2) 26 received 2% mepivacaine with 0.1 mg fentanyl; 3) 19 received 0.5% bupivacaine with placebo and 4) 20 patients received 0.5% bupivacaine with 0.1 mg fentanyl. The levels of the sensory blockade was comparable in all groups. The degree of motor-blockade was more intense in the mepivacaine groups, but the blockade by mepivacaine lasted shorter. Addition of fentanyl did not change the sensory and motor blockade. Intraoperative pain was reported by: 7 patients in the mepivacaine/placebo group; 4 patients in the mepivacaine/fentanyl group; 4 patients in the bupivacaine/placebo group; and by one patient in the bupivacaine/fentanyl group. These results indicate that fentanyl enhances the quality of epidural blockade when combined with either mepivacaine or bupivacaine.

A method to quantitate cell numbers of muscle cells and non-muscle cells in homogenised heart cell cultures.

Neonatal rat heart cell cultures are popular research models in cardiovascular investigations. A major disadvantage is the variable contribution of non-muscle cells to the cultures. As biochemical and pharmacological quantities are generally measured in homogenised cultures, we looked for a method to calculate numbers of muscle cells and non-muscle cells per culture after homogenisation. By means of a model based on the presence of one diploid nucleus per myocyte and per non-muscle cell, a nuclear DNA content of 7.5 pg, and a constant ratio of DNA content and sum of the lactate dehydrogenase isoenzymes LDH-4 and LDH-5 (DNA/LDH4+5 = 11.6 +/- 1.5 micrograms.U-1) in non-muscle cells, we calculated that in 21 neonatal rat heart cell cultures, cultured for 0-6 days, the number of muscle cells was 1.5 X 10(6) per culture, independent of time; and the number of non-muscle cells was low at day 0 (1.6 X 10(5) per culture), increasing to 4 X 10(6) per culture at day 6. Based on a time dependent increase in lactate dehydrogenase content per muscle cell we showed that muscle cells in culture underwent progressive hypertrophy: in 6 days myocyte volume increased fourfold. Thus, by measurement of DNA content and the activities of lactate dehydrogenase and its isoenzymes in a homogenised culture the cellular composition of the culture can be assessed quantitatively.