Does level of sedation impact detection of advanced neoplasia?

BACKGROUND AND AIMS: Two of the foremost issues in screening colonoscopy involve delivering quality and maximizing adenoma detection rates (ADR). Little is known about the impact of deep sedation on ADR. This study aims to compare the detection of advanced lesions during screening colonoscopy performed with moderate conscious sedation (MCS) versus deep sedation (DS). METHODS: A retrospective cohort study was performed using the Clinical Outcomes Research Initiative database. Average risk screening colonoscopies performed January 2000 to December 2005 were examined for practice setting, patient demographics, and findings, including detection of a polyp >9 mm and suspected malignant lesions. RESULTS: A total of 104,868 colonoscopies were examined, 97% of which were performed with MCS. Univariate analysis demonstrated that more polyps of any size were detected with MCS (38 vs. 34%, p < 0.0001) and more advanced lesions were found with DS compared with MCS (7 vs. 6%, p = 0.01). When exclusively examining sites that performed DS > 10% for all procedures, a more significant increase in advanced lesion detection when using DS was observed (7.5 vs. 5.7%, p = 0.003). When adjusted for age, gender, race/ethnicity, site, prep quality, and ASA group, DS was 25% more likely to detect an advanced lesion. CONCLUSIONS: Our data suggest that use of DS may be associated with a higher rate of advanced lesion detection. However, this retrospective design has limitations that necessitate follow-up with prospective studies. These follow-up studies would be essential to support any change in the standard practices of sedation.

Constipation is not associated with an increased rate of findings on colonoscopy: results from a national endoscopy consortium.

BACKGROUND AND STUDY AIMS: There are no definite guidelines regarding colonoscopic evaluation for the indication of constipation, a common gastrointestinal complaint. The aim of our study was to determine the risk of finding significant lesions in patients undergoing colonoscopy for the indication of constipation alone compared with constipation with another indication or average-risk screening. PATIENTS AND METHODS: A retrospective review of the Clinical Outcomes Research Initiative database was carried out for colonoscopies undertaken between 1 January 2000 and 30 June 2003. A total of 41,775 index colonoscopies performed for the indications of average-risk screening, constipation only or constipation with another indication were identified. Logistic regression analyses were performed for constipation alone versus constipation with another indication, and for constipation alone versus average-risk screening. RESULTS: Constipation alone did not show any increased risk of significant findings on colonoscopy. Constipation and the presence of another indication, however, had a statistically significant increased risk of a significant finding on colonoscopy. The indication of constipation alone had a lower risk of significant findings on colonoscopy compared with average-risk screening. Variations in the definition of constipation used was a limitation of the study. CONCLUSIONS: Colonoscopy for constipation alone has a lower yield for significant findings compared with average-risk screening and constipation with another indication; hence, colonoscopy should not be done for constipation alone.

[Tuberculosis in Czech Republic in the year 2007]. / Tuberkulóza v Ceské republice v roce 2007.

BACKGROUND: The number of notified tuberculosis cases in the Czech Republic decreased in the year 2007. 871 new tuberculosis cases and relapses were reported in the year 2007 (8.4/100 000 inhabitants). METHODS AND RESULTS: 744 cases were pulmonary tuberculosis (7.2/100 000) and from them 506 were definite pulmonary cases (4.9/100 000). In 2007 266 smear-positive cases of pulmonary tuberculosis were diagnosed. The decreasing trend in tuberculosis incidence reported since 1998 has continued. Only 14.7% of new cases of pulmonary tuberculosis were discovered by active case-finding. CONCLUSIONS: Next targets of tuberculosis control in the Czech Republic must be an active case-finding in high-risk groups and monitoring of latent tuberculosis infection.

[Tuberculosis in the Czech Republic during 2006]. / Tuberkulóza v Ceské republice v roce 2006.

BACKGROUND: In the Czech Republic the number of all notified tuberculosis cases decreased in the year 2006. 973 (9.5/100,000) all tuberculosis cases of new diseases and relapses were reported. 799 cases (7.8/100,000) were pulmonary tuberculosis and from them 556 cases (5.5/100,000) were definite pulmonary tuberculosis. In 2006 267 cases of smear positive pulmonary tuberculosis were detected. The decrease in tuberculosis notification rate reported in the Czech Republic since 1998 has continued. METHODS AND RESULTS: The resistance for antituberculotic drugs was 7.4% and MDR-TB cases were detected in 1.4% of all bacteriologically confirmed cases. The low level of resistance, good treatment constitutes presumption of further decline in tuberculosis in the Czech Republic. CONCLUSIONS: The majority of tuberculosis cases were diagnosed because of symptoms (74.7%)-passive case-finding. By active case-finding only 11.7% of new pulmonary tuberculosis were detected. In Prague only 6.7% of all pulmonary tuberculosis cases were diagnosed by active case-finding. Next target of tuberculosis control in the Czech Republic will be to increase the percentage of active case-finding in high-risk groups and to monitor latent tuberculosis infection in our population.

[Tuberculosis in the Czech Republic in 2005]. / Tuberkulóza v Ceské republice v roce 2005.

BACKGROUND: The number of notified TB cases decreased in the year 2005, when 1007 new TB cases and relapses were reported (9.9/100,000 inhabitants). METHODS AND RESULTS: 838 cases were pulmonary TB (8.2/100,000) and from them 586 were definite pulmonary cases (5.7/100,000). The decreasing trend in TB incidence reported since 1998 has continued. The treatment of definite pulmonary cases notified in 2004 and evaluated in 2005 was effective. Treatment success was in 80.7 % of cases, but failures and interrupted treatment were only 2.5 % of cases. Only 14.7 % new cases of pulmonary TB were found by active case-finding. CONCLUSIONS: Next targets of TB control must be an active case-finding in high-risk groups and monitoring latent TB infection.

Risk factors for cardiopulmonary events during propofol-mediated upper endoscopy and colonoscopy.

BACKGROUND: Propofol-mediated sedation for endoscopy is popular because of its rapid onset and recovery profile. AIM: To examine procedure-specific occurrence and risk factors for cardiopulmonary events during propofol-mediated upper endoscopy (EGD) and colonoscopy. DESIGN: A cohort study using the Clinical Outcomes Research Initiative database was used to determine the frequency of cardiopulmonary events. Clinical Outcomes Research Initiative consisted of 69 practice sites comprising 593 US endoscopists. Multivariate logistic regression analysis used variables, such as age, ASA classification and propofol administration by monitored anaesthesia care or gastroenterologist-administered propofol to determine the risk of cardiopulmonary events. RESULTS: The overall cardiopulmonary event rate for 5928 EGDs and 11 683 colonoscopies was 11.7/1000 cases. For colonoscopy, ascending ASA classification was associated with an increased risk. Monitored anaesthesia care was associated with a decreased adjusted relative risk (0.5, 95% CI: 0.36-0.72). ASA I and II patients receiving monitored anaesthesia care for EGD exhibited a significantly lower relative risk (ARR 0.29, 95% CI: 0.14-0.64). For subjects with ASA class III or greater, there was no difference in the risk between monitored anaesthesia care and gastroenterologist-administered propofol. CONCLUSIONS: There are procedure-specific risk factors for cardiopulmonary events during propofol-mediated EGD and colonoscopy. These should be taken into account during future prospective comparative trials.

A Caenorhabditis elegans tissue model of radiation-induced reproductive cell death.

We have developed a tissue model of radiation-induced reproductive cell death in the nematode Caenorhabditis elegans. Reproductive cell death is the primary mode of death in tissue multipotential precursor cells, or "clonogens," the targets of cytotoxic therapy, whose elimination results in normal tissue damage as well as solid-tumor eradication. Through extensive morphologic and genetic analysis, we have confirmed that cell death in this model represents reproductive cell death in isolation from apoptotic cell death, affording the opportunity to define the genetic pathways required for protection from reproductive cell death. We have additionally found that the DNA damage response pathway is necessary for protection from reproductive cell death, supporting the long-held tenet that DNA damage is the cause of reproductive cell death and further validating this model. This genetic tissue model provides a valuable tool for oncology-based research and affords a platform to broaden our insight into responses to cytotoxic therapy in tissues.

Variation in practice of ileal intubation among diverse endoscopy settings: results from a national endoscopic database.

BACKGROUND: Terminal ileum intubation rates at colonoscopy are variable. One of the major indications for terminal ileum intubation is to identify Crohn's disease. Signs and symptoms which raise a suspicion of Crohn's include abdominal pain/bloating, anaemia and diarrhoea. AIM: To determine the proportion of terminal ileal intubation in patients undergoing evaluation of abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy. METHODS: The Clinical Outcomes Research Initiative national endoscopic database was analysed to determine the proportion of terminal ileum intubation in patients undergoing evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy and to characterize this population of patients. Patients with known or suspected inflammatory bowel disease were excluded from the analysis. RESULTS: Between January 2000 and December 2003, 21 638 patients underwent complete colonoscopy for evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal colon findings. Overall, 3858 patients (18%) underwent terminal ileum evaluation. Intubation rates differed according to procedure indication: abdominal pain (13%), anaemia (13%), diarrhoea (28%). Terminal ileum assessment declined with advancing patient age and was least frequent in Black patients (12% vs. 18% in non-Blacks, P < 0.0001). Ileal intubation rates also varied among endoscopy site types: community (17%), academic (21%), Veterans Affairs Medical Centres (17%), P < 0.0001. Multiple logistic regression identified patients with the indication of diarrhoea (OR: 2.58) as more likely to undergo terminal ileum intubation when compared with those with abdominal pain/bloating. Patients in Veterans Affairs (OR: 1.26) and academic (OR: 1.29) sites were more likely to undergo terminal ileum intubation compared with community sites. CONCLUSION: Less than one-fifth of patients with either abdominal pain/bloating, anaemia or diarrhoea underwent ileal intubation in the setting of a normal colonoscopy. Significant practice variation was observed in rates of terminal ileum evaluation. Further study is required to determine whether terminal ileum examination impacts patient management or outcome.

European health systems and cancer care.

INTRODUCTION: Data on the survival of all incident cases collected by population-based cancer registries make it possible to evaluate the overall performance of diagnostic and therapeutic actions on cancer in those populations. EUROCARE-3 is the third round of the EUROCARE project, the largest cancer registry population based collaborative study on survival in European cancer patients. The EUROCARE-3 study analysed the survival of cancer patients diagnosed from 1990 to 1994 and followed-up to 1999. Sixty-seven cancer registries of 22 European countries characterised by differing health systems participated in the study. This paper includes essays providing brief overviews of the state and evolution of the health systems of the considered countries and comments on the relation between cancer survival in Europe and some European macro-economic and health system indicators, in the 1990s. OVERVIEW OF THE EUROPEAN HEALTH SYSTEMS: The European health systems underwent a great deal of reorganisation in the last decade; a general tendency being to facilitate expanding involvement of the private sector in health care, a process which occurred mainly in the eastern countries (i.e. the Czech Republic, Estonia, Poland, Slovakia and Slovenia). In contrast, organisational changes in the northern European countries (i.e. Denmark, Iceland, Finland and Sweden) tended to confirm the established public sector systems. Other countries, including the UK and some southern European countries (i.e. England, Scotland, Wales, Malta and Italy) have reduced the public role while the systems remain basically public, at least at present. Our findings clearly suggest that cancer survival (all cancer combined) is related to macro-economic variables such as the gross domestic product (GDP), the total national (public and private) expenditure on health (TNEH) and the total public expenditure on health (TPEH). We found, however, that survival is related to wealth (GDP), but only up to a certain level, after which survival continues to be related to the level of health investment (both TNEH and TPEH). According to the Organisation for Economic Co-operation and Development (OECD), the TNEH increased during the 1990s in all EUROCARE-3 countries, while the ratio of TPEH to TNEH reduced in all countries except Portugal. CONCLUSIONS: Cancer survival depends on the widespread application of effective diagnosis and treatment modalities, but our enquiry suggests that the availability of these depends on macro-economic determinants, including health and public health investment. Analysis of the relationship between health system organisation and cancer outcome is complicated and requires more information than is at present available. To describe cancer and cancer management in Europe, the European Cancer Health Indicator Project (EUROCHIP) has proposed a list of indicators that have to be adopted to evaluate the effects on outcome of proposed health system modifications.

Ten-vertex rhodadithiaborane chemistry:.

Neutral 8-(5-iodo-n-pentyl)-3-(eta(5)-pentamethylcyclopentadienyl)-arachno-3-rhoda-7,8-dithiaundecaborane, [Rh(C(5)H(19)B(8)IS(2))(C(10)H(15))], obtained from the [arachno-7,8-S(2)B(9)H(10)](-) anion by treatment with I(CH(2))(5)I followed by [Rh(C(5)Me(5))Cl(2)](2) and N,N,N',N'-tetramethyl-1,8-diaminonaphthalene, has the 11-vertex cluster geometry of [arachno-7,8-S(2)B(9)H(10)](-), but with an [Rh(C(5)Me(5))] unit in the 3-position instead of a [BH] unit, and with a -(CH(2))(5)I chain attached exo to an S atom.

Phosphacarborane chemistry: the 7,8,9,11-, 7,9,8,10- and 7,8,9,10-isomers of nido-P2C2B7H9--diphosphadicarbaborane analogues of 7,8,9,10-C4B7H11.

The reaction between the carborane arachno-4,6-C2B7H13 (1) and PCl3 in dichloromethane in the presence of a "proton sponge" (PS = 1,8-dimethylaminonaphthalene) resulted in the isolation of the eleven-vertex nido-diphosphadicarbaboranes 7,8,9,11-P2C2B7H, (2) and 3-Cl-7,8,11-P2C2B7H, (3-Cl-2) in yields of 54 and 7%, respectively. Replacement of the PS by NEt3 in the same reaction gave diphosphadicarbaboranes 2 and 3-CI-2 together with the isomeric species nido-7,9,8,10-P2C2B7H, (3) in yields of 28, 15 and 3%, respectively. The reaction between the isomeric carborane arachno-4,5-C2B7H13 (4) and PCl3 in dichloromethane in the presence of PS gave the asymmetrical isomer, nido-7,8,9,10-P2C2B7H, (5). along with the chloro derivatives 4-Cl-7,8,9,10-P2C2B7H8 (4-Cl-5) and 11-Cl-7,8,9,10-PC2B7,H8 (11-Cl-5) (yields of 21, 1 and 13%, respectively). The structures of the chlorinated derivatives 3-Cl2 and 11 -Cl-5 were determined by X-ray diffraction analysis. In addition, the structures of all compounds isolated were geometry-optimised and confirmed by comparison of experimental 11B chemical shifts with those calculated by the GIAO-SCF/II//RMP2(fc)/6-31G* method. The calculations also include the structure and 11B NMR shifts of the isomer nido-7,10,8,9-P2C2B7H9 (6) which has not yet been isolated.

Monocarbaborane chemistry. Preparation and characterisation of [4-CB8H9]-, the 'missing' closo-carbaborane anion.

Thermolysis in the solid state of Cs+[arachno-CB9H14]-, or of Cs+[nido-CB9H12]-, or the oxidation of nido-1-CB8H12 with I2 in THF at -78 degrees C in the presence of NEt3, gives the first nine-vertex closo monocarbaborane, the stable [closo-4-CB8H9]- anion, in yields of 56, 61 and 75%, respectively.

[1,1,2,2-]

The title compound, 1,1,2,2-tetracarbonyl-1,2-&mgr;-carbonyl-4, 11-dimethylsulfido-closo-1,2-dicobaltadodecaborane, [Co(2)(C(4)H(20)B(10)S(2))(CO)(5)], has a closo 12-vertex 1, 2-Co(2)B(10)H(8) structure with SMe(2) ligands at the exo-4- and 11-positions. The cluster displays close structural similarities to the SEt(2) analogue.

Unusual 9-->10 rearrangement of the substituted cage carbon in the ferratricarbollide series. Synthesis of the isomeric complexes [2-eta 5-(C5H5)-10-X-closo-2,1,7,10-FeC3B8H10] (where X = H2N, MeHN, Me2N, and ButHN).

Treatment of the zwitterionic amine tricarbollides of general formula 7-L-nido-7,8,9-C3B8H10 (1) (where L = Me2HN (1c) and ButH2N (1d)) with [(eta 5-C5H5)Fe(CO)2]2 in refluxing mesitylene resulted in the formation of a mixture of the known compounds [2-(eta 5-C5H5)-9-X-closo-2,1,7,9-FeC3B8H10] (2) (where X = H2N (2a), Me2N (2c), and ButHN (2d)) and a series of new, isomeric ferratricarbollylamines [2-(eta 5-C5H5)-10-X-closo-2,1,7,10-FeC3B8H10] (3) (where X = H2N (3a), Me2N (3c), and ButHN (3d)) in moderate yields. Complexes of type 3 (where X = H2N (3a), MeHN (3b), Me2N (3c), and ButHN (3d)) were also obtained readily by heating complexes of type 2 (where X = H2N (2a), MeHN (2b), Me2N (2c), ButHN (2d), and Bu(t)(Me)N (2e)) at ca. 300 degrees C for 10 min. All the complexes of type 3 contain reactive amine functions in meta positions with respect to the metal center. The observed 9-->10 rearrangement of the substituted cluster carbon is quite unexpected and is believed to result from higher thermodynamic stability of the 10-substituted isomers. The structures of all compounds of type 3 were established by high-field NMR spectroscopy and mass spectrometry, and that of 3d was determined by an X-ray diffraction study.

[Hospitalization during pregnancy--the professional versus the economic viewpoint]. / Hospitalizace v tehotenství--hledisko odborné versus ekonomické.

The high percentage of hospitalized pregnant women in the Czech Republic was analyzed form the cost benefit aspect within the framework of the current transformation of the health services which restricts in-patient care in favour of ambulatory care, as part of the developing market economy. Two internationally accepted indicators of quality of perinatal morbidity-maternal (rate of eclampsia) as well as neonatal (rate of low birth weight infants), i.e. partially preventable prenatal hospitalizations. In a comparative epidemiological study the incidence of these indicators in the Czech Republic was compared with the incidence in Hessen where there is a lower rate of prenatal hospital admissions, while there is a similar system of perinatal care and general perinatal mortality. In the Czech Republic where the cost of hospitalization of pregnant women is higher, the authors found as regards the benefit a lower incidence of the mentioned two indicators and from the economic aspect a lower cost of neonatal intensive care than in Hessen. This saving was fourfold as compared with the higher costs of prenatal hospitalization.

[A method for studying total population morbidity in the Czech Republic in 1986]. / Metodika setrení celkové nemocnosti populace CR r. 1986.

The authors evaluate the method applied in an extensive investigation of the general morbidity of the Czech population implemented in 1986, based on treated morbidity, not combined with the method of actual medicinal examinations. The population sample was selected by one-stage selection, randomization was made by birth data (seventh day in odd month). In the investigation participated all health community and factory doctors, as well as paediatricians and adolescent medical officers in the Czech Republic. Morbidity was assessed retrospectively from the documentation of health community doctors. The investigation confirmed the hypothesis that this method can be used under local conditions for periodic examinations of the general morbidity of the population.

Nutritional and hormonal regulation of mRNA abundance for arginine biosynthetic enzymes in kidney.

Argininosuccinate synthetase and argininosuccinate lyase catalyze the synthesis of arginine from citrulline in kidney and also serve as components of the urea cycle in liver of ureotelic animals. Dietary and hormonal regulation of mRNAs encoding these enzymes have been well studied in liver but not in kidney. Messenger RNAs for these enzymes are localized within the renal cortex. Starvation and extreme variations in dietary protein content (0% vs 60% casein) produced 2.6- to 3.5-fold increases in mRNA abundance for these two enzymes in rat kidney. Argininosuccinate lyase mRNA was not induced by dibutyryl cAMP, dexamethasone, or a combination of the two agents. In contrast, argininosuccinate synthetase mRNA was induced 2-fold by dibutyryl cAMP but was unresponsive to dexamethasone. Thus, diet and hormones regulate levels of these mRNAs in rat kidney, but the responses are both qualitatively and quantitatively distinct from the responses previously reported for rat liver.