Case controlled study of the hospital stay and return to full activity following laparoscopic and open colorectal surgery before and after the introduction of an enhanced recovery programme.

AIM: The short-term benefits of laparoscopic surgery are well established and in particular within an enhanced recovery programme. Early return to activity is to be expected but has not been quantified widely. The aim of this study was to measure the hospital stay and return to full activity following laparoscopic colorectal surgery and compare this with a matched group of patients undergoing open colorectal resections before and after the introduction of an enhanced recovery programme. METHOD: Retrospective analysis of all laparoscopic colorectal operations performed between January 2003 and June 2007 on an intention to treat basis compared with a matched group of patients undergoing elective open colorectal surgery at the same institution. RESULTS: The median hospital stay following 179 laparoscopic colorectal resections was 6 days whilst following 144 conventional open operations it was 8 days. Following the introduction of an enhanced recovery programme the hospital stay fell from 7 to 5 days and from 9 to 7 days for laparoscopic and open groups respectively. The median return to full activity from surgery for laparoscopic patients was 13 days in comparison to 56 days for patients undergoing open colorectal surgery. CONCLUSIONS: Following laparoscopic colorectal resection, patients can be expected to have a hospital stay of under a week and return to their usual activities as early as a week after discharge from hospital and < 2 weeks from surgery in comparison to patients undergoing open surgery who take 8 weeks or more to recover.

Selenium compounds have disparate abilities to impose oxidative stress and induce apoptosis.

The cancer chemopreventive effect of selenium cannot be fully accounted for by the role of selenium as a component of the antioxidant enzyme glutathione peroxidase, which suggests that chemoprevention occurs by another mechanism. Several studies have shown that thiol oxidation and free radical generation occur as a consequence of selenium catalysis and toxicity. In the present study, we evaluated three different selenium compounds; selenite, selenocystamine, and selenomethionine to determine the relative importance of the prooxidative effects of these compounds with regard to their ability to induce apoptosis. The experimental results suggest that, in addition to supporting an increased activity of glutathione peroxidase, an antioxidant function that the three selenium compounds did with equal efficacy, catalytic selenite, and selenocystamine generated 8-hydroxydeoxyguanosine DNA adducts, induced apoptosis and were found to be cytotoxic in mouse keratinocytes. The noncatalytic selenomethionine was not cytotoxic, did not generate 8-hydroxydeoxyguanosine adducts and did not induce cellular apoptosis at any of the selenium concentrations studied. In keratinocytes, apoptosis may be initiated by superoxide (O2*-) and oxidative free radicals that are generated by selenite and selenocystamine, but not by selenomethionine.

Induction of differentiation and apoptosis by sodium selenite in human colonic carcinoma cells (HT29).

To explore the mechanism(s) by which selenium (Se) exerts its cancer chemopreventive activity, we studied the effect of selenite (0-100 microM) on cell growth, viability, differentiation, detachment, DNA fragmentation and apoptosis in human colonic carcinoma cells (HT29). Selenite (>5 microM) decreased cell growth, increased cell detachment and decreased intracellular levels of reduced glutathione (GSH), whereas >10 microM selenite induced cell differentiation and apoptosis. The chemopreventive effects of selenite may be related in part to the generation of reactive oxygen species (ROS) resulting from the reaction between selenite and GSH.

Antioxidant nutrients protect against UVB-induced oxidative damage to DNA of mouse keratinocytes in culture.

Ultraviolet B radiation (UVB) induces oxidative damage in DNA, resulting in the formation of the adduct 8-hydroxydeoxyguanosine. Previous studies from this laboratory have demonstrated a decrease in antioxidant enzyme defenses after UVB radiation in Skh: HR-1 hairless mice, implicating antioxidant status in protection against oxidative damage. The present study was undertaken to examine mechanisms of UVB damage to DNA and modulation by vitamin C, selenite, or Trolox, a water-soluble vitamin E analog. BALB/c MK-2 mouse keratinocytes were exposed to a dose range of UVB from 4 to 750 mJ/cm2. DNA damage in the form of 80 HdG was measured using high-pressure liquid chromatography coupled with electrochemical and UV absorbance detection. Preincubation of the cells for 2 days with 0.4 or 0.8 microgram/ml ascorbic acid, 10 or 20 micrograms/ml Trolox, and 5 or 12.5 microM selenite resulted in a significant decrease in the number of 8-hydroxydeoxyguanosine adducts per 10(5) deoxyguanines induced by 500 mJ/cm2 UVB. The results indicate a potential role for antioxidant nutrients in protection against UVB damage to skin cells.

National health expenditures, 1993.

This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically.

How schools perceive the school health service.

An awareness by health professionals of changing priorities facing the School Health Service (SHS) has led to increased attempts to evaluate current practice. In the present study we set out to examine how schools perceive the SHS, to identify their concerns and obtain their suggestions for improvements. Despite direct and repeated personal communication, only 26 questionnaires were returned out of 64 sent to primary and post primary schools. The majority of responses indicated a lack of knowledge about the various aspects of the SHS and a request for more information. Half the questionnaires indicated dissatisfaction with the current SHS--particular problems identified were poor communication, lack of information and inability to deal with social problems. Suggestions made by schools to improve the SHS include improved communication between schools, SHS and parents, better and increased health education. Schools identified the current health needs of pupils as health education; social, family and behavioural problems; and developmental problems. Overall those schools who responded welcomed the approach from the SHS.

Computer-aided pattern analysis of temperature differentials.

Chiropractic analysis often incorporates the evaluation of heat distribution patterns observed in skin temperature profiles. Historically, temperature recordings of the spine have been made with a heat detection instrument using a thermocouple design. The advent of refinements in infrared technology, however, have greatly enhanced temperature detection in terms of accuracy and reliability. The present research reflects the development of computer software designed to express the data obtained with a dual channel heat sensing instrument. Two phases are involved: a) digital information, received from the sensing instrument, is standardized, stored for future analysis, and retrieved for comparisons with other graphs; b) stored data is graphically displayed, statistically analyzed, and otherwise compared. The data is displayed for visual observation as a) temperature data received from either channel of the sensing instrument or b) relative temperature differences between data from both channels of the sending instrument. For statistical evaluation, corresponding readings (comparisons between graphs) are plotted against one another and analyzed by a moving Pearson Product Moment correlation and moving t-test. This evaluation is graphically represented with a numeric display of pertinent statistical values. Current work indicates that a 10 point moving correlation and t-test will yield accurate comparisons between graphs.

Paraquat poisoning: significance of plasma-paraquat concentrations.

Plasma-paraquat concentrations were measured in 79 patients who had ingested liquid or granular weedkillers containing paraquat. At any given time after ingestion, the plasma-paraquat concentrations in the patients who died usually exceeded those in the survivors. It is suggested that measurement of plasma-paraquat concentrations is useful in assessing the severity and predicting the outcome of poisoning. Patients whose plasma concentrations do not exceed 2.0, 0.6, 0.3, 0.16, and 0.1 mg/l at 4, 6, 10, 16, and 24 h respectively are likely to survive.