Screening of first degree relatives of patients operated for colorectal cancer: evaluation of fecal calprotectin vs. hemoccult II.

UNLABELLED: Fecal calprotectin (CPT) is elevated in the majority of patients with known colorectal cancer (CRC), but the specificity is not clarified. AIM: To evaluate if a CPT test (PhiCal ELISA) was more sensitive than Hemoccult II test in detecting colorectal neoplasia, and to obtain reference values in subjects with normal colonoscopy. To evaluate a possible relation between number and extent of dysplasia of adenomas in first degree relatives of patients with CRC and the stage of the carcinoma in the index casus. Further to study the prevalence of CRC and adenomas in the first degree relatives of patients operated for CRC. METHOD: In a multicenter study, 253 first degree relatives of patients with CRC, aged 50-75 years (mean age 60 years) underwent colonoscopy after having delivered stool samples and three Hemoccult II slides. RESULTS: In 237 first degree relatives from 148 patients with CRC, polyps were found in 118 (50%). Seventy three (31%) had adenomas and 17 had adenomas > or =10 mm. Five had asymptomatic cancers. The specificity of fecal CPT for adenomas at cut off levels 15 mg/l. The sensitivity of Hemoccult II for adenomas was 8%, and 4/5 of patients with carcinoma had negative Hemoccult II. The specificity for adenomas was 95%. CONCLUSION: Fecal CPT test was more sensitive than Hemoccult II in detecting colorectal neoplasia but the specificity was lower. In a high risk group like first degree relatives of patients with CRC, there are good reasons to consider fecal CPT as a first test in selecting patients for endoscopy.

A new fecal calprotectin test for colorectal neoplasia. Clinical results and comparison with previous method.

BACKGROUND: Fecal calprotectin is elevated in patients with colorectal cancer (CRC). An improved method has been developed. The aim was to evaluate sensitivity and specificity for CRC with the new fecal calprotectin method and to compare the results with those of the original method. METHODS: The study comprised 453 subjects including symptomatic CRC patients and CRC high risk subjects with and without CRC. Complete colonoscopy was performed. Calprotectin was measured with an enzyme linked immunosorbent assay (ELISA) using small (50-100 mg) feces samples. RESULTS: Fecal calprotectin levels were significantly elevated in symptomatic CRC and in asymptomatic CRC detected in high risk subjects. Calprotectin levels were significantly decreased 3 months after cancer removal. A cut-off limit of 50 microg/g resulted in a sensitivity of 89% in CRC patients and 79% in high risk subjects, compared to 89% and 75%, respectively, with the original method, using 10 mg/l as cut-off limit. Specificity was improved with the new method to 68% and 91% at cut-off of 50 and 150 microg/g, compared to 66% and 88%, respectively. Negative predictive value (NPV) was 99% for cut-off of 50 microg/g in the high risk population. One stool sample was sufficient, but measurement of two spots in two stools increased sensitivity to 98% for symptomatic and 82% for asymptomatic CRC. CONCLUSION: The new simple method, using small samples of feces, had a higher diagnostic accuracy, suggesting that it should be preferred to the original one, in screening high risk groups for CRC.

Fecal excretion of calprotectin in colorectal cancer: relationship to tumor characteristics.

BACKGROUND: The aim of this study was to evaluate fecal calprotectin in patients treated for colorectal cancer. Furthermore, the changes in fecal calprotectin concentration from before to after surgery were investigated. METHODS: In 155 patients with newly diagnosed colorectal cancer, two spot samples were taken from the same feces on two consecutive days. RESULTS: Three ways of evaluating calprotectin excretion were compared, (1st spot 1st stool; maximum of 1st spot 1st stool and 2nd spot 1st stool; maximum of 1st spot 1st stool and 1st spot 2nd stool) and gave similar results with median fecal calprotectin values 47 mg/l, 52 mg/l and 54 mg/l, respectively. Median calprotectin concentration did not differ significantly between different tumor stages, although the levels were slightly lower in Dukes stage A tumor than in the rest of the stages. Neither were there any differences in the concentrations related to the localization, size or the histological grading of the carcinoma. As the currently used cut-off level for fecal calprotectin is 10 mg/l, 87% of all patients had elevated fecal calprotectin. Seventy-nine percent of the patients had levels above 15 mg/l and 74% had levels above 20 mg/l (1st spot 1st stool). In patients who delivered fecal samples after the operation the calprotectin value fell significantly from a preoperative median value of 45 mg/l to 14 mg/l after the resection. CONCLUSIONS: The majority of patients with colorectal cancer have increased fecal concentration of calprotectin. One single fecal spot seems to be sufficient for determination of the calprotectin level. Measurement of fecal calprotectin may possibly become of value as a marker for colorectal cancer, although calprotectin, similar to fecal occult blood (FOB) tests, is a non-specific test for colorectal pathology, also being elevated in inflammatory bowel diseases. Further investigation of its specificity is therefore needed.

Faecal calprotectin levels in a high risk population for colorectal neoplasia.

BACKGROUND: Faecal concentrations of the protein calprotectin have been found to be elevated in patients with colorectal neoplasia, suggesting that it might be used as a screening tool for colorectal cancer as well as adenomas. AIMS: To measure the sensitivity and specificity of faecal calprotectin for the detection of adenomas in high risk individuals undergoing colonoscopy. Also, to investigate between and within stool variability of calprotectin concentrations. SUBJECTS: A total of 814 patients planned for colonoscopy were included for the following indications: positive faecal occult blood test, 25; neoplasia surveillance, 605; newly detected polyp, 130; and family risk, 54. METHODS: Two faecal samples from each of two stools were analysed using the PhiCal ELISA test device (Nycomed Pharma AS). RESULTS: Adenoma patients had significantly higher calprotectin levels than normal subjects (median 9.1 (95% confidence interval 7.5-10.1) v 6.6 (5.6-7.4)mg/l). There was no significant decrease in calprotectin levels after polypectomy. Levels in cancer patients were significantly higher than those in all other subgroups (median 17.6 mg/l (11.5-31.0)). With a cut off limit of 10 mg/l, the sensitivity for cancer was 74% and for adenoma 43%. Corresponding specificity values were 64% for no cancer and 67% for no neoplasia (cancer+adenoma). Specificity varied from 71% for one stool sample to 63% for four samples. Stool variability was small, suggesting that two spots from one stool were as discriminative as two spots from each of two stools. CONCLUSIONS: The sensitivity and specificity of faecal calprotectin levels as a marker for colorectal adenoma and carcinoma justifies its use in high risk groups, but specificity is too low for screening of average risk persons. Lack of a decrease in levels after polypectomy may be due to a more widespread leucocyte migration into the intestinal lumen than that at the polyp site, and needs further investigation.

Increased risk of obstructive pulmonary disease in tunnel workers.

BACKGROUND: Tunnel workers are exposed to gases and particles from blasting and diesel exhausts. The aim of this study was to assess the occurrence of respiratory symptoms and airflow limitation in tunnel workers and to relate these findings to years of exposure. METHODS: Two hundred and twelve tunnel workers and a reference group of 205 other heavy construction workers participated in a cross sectional investigation. Exposure measurements were carried out to demonstrate the difference in exposure between the two occupational groups. Spirometric tests and a questionnaire on respiratory symptoms and smoking habits were applied. Atopy was determined by a multiple radioallergosorbent test (RAST). Radiological signs of silicosis were evaluated. Respiratory symptoms and lung function were studied in relation to years of exposure and adjusted for smoking habits and atopy. RESULTS: Compared with the reference subjects the tunnel workers had a significant decrease in forced vital capacity (FVC) % predicted and forced expiratory volume in one second (FEV(1)) % predicted when related to years of exposure. Adjusted FEV(1) decreased by 17 ml for each year of tunnel work exposure compared with 0.5 ml in outdoor heavy construction workers. The tunnel workers also reported significantly higher occurrence of respiratory symptoms. The prevalence of chronic obstructive pulmonary disease (COPD) was 14% in the tunnel workers compared with 8% in the reference subjects. CONCLUSION: Exposure to dust and gases from diesel exhaust, blasting, drilling and rock transport in tunnel work enhances the risk for accelerated decline in FEV(1), respiratory symptoms, and COPD in tunnel workers compared with other heavy construction workers.

Asthma in tunnel workers exposed to synthetic resins.

OBJECTIVES: The prevalence of asthma among tunnel workers exposed to synthetic resins was studied by determining airway symptoms, methacholine responsiveness, and lung function. METHODS: Nineteen injection workers were compared with a group of 104 other tunnel workers with similar exposure, except for that to synthetic resins. A questionnaire on respiratory symptoms, smoking habits, use of respiratory protection, and work tasks was used. Lung function was studied using a bellows spirometer. Bronchial reactivity was tested with methacholine. Allergy screening with Phadiatop and radioallergosorbent tests for toluene-diisocyanate-HSA, diphenylmethane-4.4-diisocyanate-HSA, and formaldehyde-HSA (HSA = human serum albumin) were carried out. Methylene diphenyl diisocyanate (MDI) and MDI prepolymer exposure was estimated by filter sampling, and the filters were analyzed by high-performance liquid chromatography. The most common work situations were simulated for an estimation of exposure to isocyanates. RESULTS: The injection workers reported more respiratory symptoms than the reference group, and they had higher prevalences of bronchial hyperresponsiveness (37% versus 14%), asthma (26% versus 1%), and airflow limitation (37% versus 4%). Toluene-diisocyanate-HSA-specific immunoglobulin E antibodies were found in 2 of the 19 injection workers, but in none of the other tunnel workers. By simulation at a worksite, the average exposure to polymerized MDI was estimated to be 5.5-300 microg/m3 during injection work and 18-4300 microg/m3 during short-term exposure, the highest exposure occurring when cured polyurethane was ground. CONCLUSIONS: Exposure to partly decomposed MDI in tunnel work enhances the risk for respiratory symptoms, methacholine hyperresponsiveness, asthma, and airflow limitation.

Effects of weight loss on single meal eating behaviour in obese subjects.

In 22 obese patients the eating pattern during a single meal as evaluated by the universal eating monitor VIKTOR was assessed after one year of treatment, initially with VLCD (Nutrilett) followed by combined long term diet, exercise and behavioural modification, underscoring the importance of appropriate meal habits. A mean weight loss from 117 to 101 kg was achieved. Before treatment a decelerated eating curve was found; after treatment this curve changed significantly towards a flatter and more linear shape.

Serum immunoglobulin G subclasses and serum immunoglobulin A in acute bronchiolitis in infants.

Serum IgG subclasses and Serum IgA were studied in 43 infants with acute bronchiolitis and 20 healthy infants. IgG subclasses were determined by a capture ELISA and IgA was quantified by turbidimetry. IgG1 concentrations were significantly lower in infants with bronchiolitis than in normal infants. The other IgG subclasses and IgA did not differ between the groups. The subgroups of infants with bronchiolitis who had previously suffered from otitis media or bronchitis, had significantly lower IgG2 than the other infants with bronchiolitis. The same was found for infants with bronchiolitis who had suffered from three or more lower respiratory tract infections. In infants who had suffered from upper or lower respiratory infections before the acute bronchiolitis, IgA was significantly higher than in infants without previous respiratory infections. Ten infants with bronchiolitis (23%) had IgG1 deficiency, that is values below the lower reference limit calculated in a population of healthy Norwegian infants. No healthy infants had any IgG1 deficiency. No infant with bronchiolitis had IgG2 or IgG3 deficiency. The low IgG1 values found in infants with acute bronchiolitis, may be one cause for infants to be more susceptible to RS virus infections.

C-reactive protein: a new rapid assay for managing infectious disease in primary health care.

Quantitative C-reactive protein (CRP) measurement has become increasingly valuable as a test for rapid diagnosis of infections in hospital medicine. CRP has not obtained the same importance in primary health care. This has, at least partly, been due to methodological difficulties, with no simple or rapid tests with quantitative results available. A new immunometric semi-quantitative assay, NycoCard CRP, has recently been developed. CRP was analysed at the local health centres by the new assay in 288 consultations where patients came because of infections. Parallel CRP values were obtained by an established reference method. The two procedures had an acceptable correlation (r = 0.85). The primary care doctors also registered the clinical information they obtained from each CRP result. CRP was helpful in indicating the presence, or absence of bacterial infection in more than half the consultations due to new infections. CRP was thought to yield more clinical information than the erythrocyte sedimentation rate in almost every case.

Publications on clinical trials with X-ray contrast media: differences in quality between journals and decades.

The objective of the present study was to investigate the quality of clinical trial publications on X-ray contrast media by use of a simple criteria list with 11 items. The publication quality in the 1960s, 1970s and 1980s and in five radiological journals was compared. One hundred and three articles retrieved from the literature and published in Br J Radiol (British), Acta Radiol (Scandinavian), Radiology (American), RöFo (German) and in Ann Radiol (French) were finally included. The adapted method seemed to be suitable for roughly assessing the quality of contrast medium publications. The present reporting standard has increased considerably since the 1960s, however a higher standard is still needed. Although the limited material gathered in our investigation does not allow unequivocal statements, the results indicate that the reporting standard of the 1980s in the selected American, British and Scandinavian radiological journals was somewhat better than in the German journal and better than in the French journal. Use of the present or other assessment methods is one tool to improve the reporting standard.