Clinical decision-making in managing changes in gastrointestinal function following cancer therapies: Is experience enough?

In patients with gastrointestinal (GI) disorders, identical symptoms may occur for many different reasons. This prospective study assessed whether experienced clinicians can predict accurately the underlying diagnosis or diagnoses contributing to specific symptoms based on the history and physical examination. Three clinicians assessed 47 patients referred for management of troublesome GI symptoms identified after treatment for cancer. Investigations were requested following our comprehensive, peer-reviewed algorithm. The clinicians then recorded their predictions as to the results of those investigations. After each patient had completed all their investigations, had received optimal management and had been discharged from the clinic, the predicted diagnoses were compared to those made. The clinicians predicted 92 diagnoses (1.9 per patient). After investigation, a total of 168 unique diagnoses were identified (3.5 per patient). Of the 92 predicted diagnoses, 41 (43%) matched the diagnosis. Of the 168 actual diagnoses identified, only 24% matched the prediction. None of the clinicians predicted the correct combination of diagnoses contributing to bowel symptoms. Clinical acumen alone is inadequate at determining cause for symptoms in patients with GI symptoms developing after cancer therapy.

Towards graphene bromide: bromination of graphite oxide.

Halogenated graphene derivatives are interesting for their outstanding physical and chemical properties. In this paper, we present various methods for the synthesis of brominated graphene derivatives by the bromination of graphite oxides. Graphite oxides, prepared according to either the Hummers or Hofmann method, were brominated using bromine or hydrobromic acid under reflux or in an autoclave at elevated temperatures and pressures. The influence of both graphite oxide precursors on the resulting brominated graphenes was investigated by characterization of the graphenes, which was carried out using various techniques, including SEM, SEM-EDS, high-resolution XPS, FTIR, STA and Raman spectroscopy. In addition, the resistivity of the brominated graphenes was measured and the electrochemical properties were investigated by cyclic voltammetry. Although the brominated graphenes were structurally similar, they had remarkably different bromine concentrations. The most highly brominated graphene (bromine concentration above 26 wt%) exhibited a C/O ratio above 44 and partial hydrogenation. Brominated graphenes with such properties could be used for reversible bromine storage or as a starting material for further chemical modifications.

[Pancreatic cancer--association with diabetes mellitus and smoking]. / Pankreatický karcinom--vztah k diabetes mellitus a kourení.

INTRODUCTION: Pancreatic cancer is a disease with rather poor prognosis. This can be explained, among other reasons, by unusually aggressive course of the tumour growth and, in the majority of cases, late, and thus further treatment limiting, diagnosis. In addition, no effective screening programme for pancreatic cancer is available and thus identification of risk factors associated with the development of pancreatic cancer represents a possible approach to diagnosing early stages of the disease. Smoking represents a general and diabetes mellitus a specific risk factor for pancreatic cancer. The aim of our prospective study in pancreatic cancer patients was to identify patients with diabetes mellitus and divide these into smokers and non-smokers--in association with the diagnosis of pancreatic carcinoma. MATERIALS AND METHODS: We included 83 patients, 50 men and 33 women, with pancreatic cancer who were divided into 3 groups--non-smokers with diabetes mellitus, smokers and smokers with diabetes mellitus; the mean age was 64.2 years in male and 59.8 years in female patients. Pancreatic cancer was confirmed histomorphologically from pancreatic biopsies or a histology of pancreatic tissue obtained during a surgery. RESULTS: Pancreatic cancer was diagnosed after 3 or more years in patients with diabetes mellitus, the majority of diagnoses in smokers were made within the first year from the first dyspeptic symptoms. We found that the proportion of patients with subsequent diagnosis of pancreatic cancer increased with the number of cigarettes smoked per day (33.3% up to 10 cigarettes per day and 66.5% over 10 cigarettes per day). The highest incidence of pancreatic cancer, in 42 persons (50.6%), was associated with concurrent diabetes and smoking. CONCLUSION: Pancreatic cancer was identified in 24% of patients with diabetes mellitus, 25.3% of smokers with no diabetes and in more than 50% of smokers with diabetes mellitus. We assume that smoking is an independent risk factor for pancreatic cancer induction and it importantly increases the risk of pancreatic cancer in patients with diabetes mellitus.

[Current methods in diagnostics and monitoring of patients with hereditary polyposis syndromes. Investigation of the small intestine]. / Soucasné vysetrovací metody v diagnostice a sledování familiárních polypóz. vysetrení tenkého streva.

BACKGROUNDS: Familial polypous syndromes include, in particular, familial adenomatous polyposis, Peutz-Jeghers syndrome and familial juvenile polyposis. The cumulative risk of developing cancer of the small intestine is higher and ranges between 5 to 13%. Close follow-up is therefore very important in the prevention of both malignant and benign complications of the basic disease. Currently there are many methods that can be offered to follow up patients with hereditary polyposis syndromes.The anatomy of the gastrointestinal tract can be investigated by endoscopy or double-contrast radiological techniques. The part of the small intestine between the duodenum and terminal ileum is difficult to reach by standard endoscopy and can only be judged by radiological enteroclysis, which has the disadvantage of exposing the patient to X-rays, moreover, it is impossible to examine the pathological findings histologically. However, new and more accurate enteroscopical (single and double-balloon, including intraoperative) methods and capsule enteroscopy have recently started to be used in routine clinical practice: Capsule endoscopy is an endoscopical method that enables us to examine the whole small intestine.This technology consists of swallowing a capsule the size of a bean that is later moved by motility of the gastrointestinal tract distally. A doctor then evaluates the record. Intraoperative enteroscopy is ever more often substituted by balloon enteroscopy. However, it remains a possibility when traditional double-balloon enteroscopy does not solve the patient's problems definitely; this occurs mainly in patients with intestinal adhesions or multiple lesions of the small intestine, endoscopically insolvable. Balloon enteroscopy is a modern endoscopic method that is used to examine the whole small intestine that also enables therapeutic efforts to be carried out when routine endoscopy is not successful. In some indications it has substituted intraoperative enteroscopy. CONCLUSION: These three methods are complementary, are connected in the examination algorithm and cannot be replaced by each other. Some authors consider them the golden standard in investigating the small intestine.

[Changes in the parameters of functional systems of donors undergoing apparatus plasmacytapheresis]. / Izmeneniia pokazateli funktsional'nykh sistem organizma donorov, podvergavshikhsia apparatnomu plazmotsitaferezu.

Apparatus plasmacytapheresis resulted in the lowering of total protein level and serum iron content in the blood as compared to the initial values. At the same time these parameters were within the range of reference standards and reached the initial levels 3-4 weeks after the completion of the plasmacytapheresis cycle.

[Use of the methods of blood protein fractionation for increasing the activity of natural anti-A and anti-B antibodies]. / Ispol'zovanie metodov fraktsionirovaniia belkov krovi dlia povysheniia aktivnosti estestvennykh anti-A, anti-B antitel.

Effectiveness has been shown of human blood serum fractionation with polyethylene glycol for isolation of anti-A and anti-B isohemagglutinins from stocks with low antibody activity, inadequate for the production of AB0-typing standards. An optimal diluent of fractions containing antibodies of the AB0 system has been selected. The reagents prepared did not differ, by their activity and specificity, from the standard ones produced from the whole sera.