[Is mucinous colorectal adenocarcinoma a distinct entity?]. / Es el adenocarcinoma colorrectal mucinoso una entidad diferente?

INTRODUCTION: Several publications have demonstrated that mucinous carcinomas of the colon and rectum are associated with certain clinicopathological and genetic peculiarities that distinguish them from non-mucinous carcinomas. The principal aim of this study was to evaluate whether the biological behavior of mucinous carcinomas differs from that of intestinal carcinomas in patients undergoing surgery for colorectal cancer. PATIENTS: Between January 1993 and December 2000, 215 patients. underwent surgery in our hospital for colorectal cancer. The patients were divided into two groups according to histological type: tumors were intestinal in 169 patients (82%) and mucinous in 36 (17.6%). Patients undergoing non-resective surgery and those with tumors of other histological types (n = 10) were excluded. RESULTS: The percentage of patients aged less than 50 years in the group with mucinous carcinoma was 19% (7/36) compared with 4% (7/169) in the non-mucinous group (p = 0.001). Regarding presenting symptoms, anemia was more frequent in patients with mucinous carcinoma (18.2% [n = 6] vs 5.7% [n = 8]) and a change in bowel habits was less frequent (15% [n = 5] vs 34.3% [n = 48]; p < 0.05). A total of 63.9% of mucinous carcinomas (n = 23) were located in the proximal colon (cecum, ascending and transverse colon) compared with 21.3% (n = 36) of non-mucinous carcinomas (p < 0.001). Surgical intention was palliative in 41.7% (n = 23.7) of mucinous carcinomas and in 23.7% (n = 40) of non-mucinous carcinomas (p < 0.05). The mean tumoral size was 6.2 2.5 cm in mucinous carcinomas and 4.7 2 in non-mucinous carcinomas (p = 0.001). Patients with mucinous carcinoma presented a higher percentage of nodal and distant metastases and a lower percentage of early stage tumors (p < 0.05). However, no differences were found in survival between the two histological types. CONCLUSION: Mucinous tumors were more frequently located in the right colon and in patients less than 50 years old and were more likely to be in more advanced stages than non-mucinous tumors but no differences were found in survival according to tumor type.

Applying an ECG database to aid decision-making in the A&E.

Accident and Emergency departments are increasingly playing a significant role in the management of acutely ill patients presenting with acute myocardial infarction. In particular, the shift towards A&E thrombolysis is helping reduce's door to needle' times. Whereas many of these patients have classic symptoms associated with obviously diagnostic ECGs, others may present diagnostic difficulties. This can be particularly true of the patient's ECG. This paper describes how an ECG database may be able to aid decision-making within the A&E department as it enables quick access to many patients' previous ECGs. In equivocal cases this can allow comparison and may determine whether or not certain changes are old or new. This information may be very useful in determining the patient's immediate management.

What's the point of ST elevation?

OBJECTIVE: The magnitude of ST elevation is a key piece of information in the decision to thrombolyse in acute myocardial infarction. The ability of clinicians to reliably identify ST elevation has not been previously assessed. This study sought to determine the variability in assessment of ST elevation in a group of doctors who commonly prescribe thrombolysis. METHODS: The study was conducted in three large teaching hospitals in Manchester, England. A convenience sample of 63 SHOs and SpRs from emergency and general medicine were recruited. Each was shown three sample ECG complexes. They were asked to identify and quantify the degree of ST elevation. They then indicated the points on the ECG from which they measured ST elevation. RESULTS: ST elevation was not identified in 12% of cases. Doctors used a wide variety of points on the ST segment to assess elevation, this resulted in a wide variation in the observed magnitude of ST elevation. CONCLUSION: No guidance exists on where exactly ST elevation should be measured. This study shows a wide variation in practice. Protocol led thrombolysis decision pathways may be compromised by these findings.

El rendimiento diagnóstico del 99mtc-sestamibi cambia según la localización y el tipo de hiperparatiroidismo. análisis multivariante / The diagnostic yield of 99mTc sestamibi changes according to localization and type of hyperparathyroidism. Multivariate analysis

El rendimiento diagnóstico del 99mTc-sestamibi cambia según la localización y el tipo de hiperparatiroidismo. Análisis multivariante Objetivos. Analizar el rendimiento diagnóstico preoperatorio del 99mTc-sestamibi en el hiperparatiroidismo teniendo en cuenta diversos factores que pueden influir en el resultado, con la finalidad de determinar si es fiable la exploración quirúrgica selectiva en el tratamiento de esta enfermedad basada en los hallazgos obtenidos en la prueba.Material y método. Se estudian mediante regresión logística los resultados en 92 glándulas de 22 pacientes con hiperparatiroidismo primario y secundario. Se calcula la sensibilidad, la especificidad y los valores predictivos introduciendo como variables independientes el tipo de hiperparatiroidismo, la localización de las glándulas afectadas, los valores de calcemia y de paratohormona y la enfermedad tiroidea concomitante.Resultados. Hubo diferencias acusadas en magnitud y estadísticamente, según el tipo de hiperparatiroidismo y la localización superior, inferior o ectópica de las glándulas patológicas. Otras variables no demostraron ninguna influencia significativa. Para los adenomas, los índices diagnósticos fueron suficientemente elevados: sensibilidad del 71-94 por ciento, especificidad del 90-97 por ciento. Para las hiperplasias secundarias la sensibilidad fue muy baja (8-37 por ciento), pero con especificidades del 100 por ciento.Conclusiones. En el caso de adenomas paratiroideos, el sestamibi puede ofrecer suficiente seguridad diagnóstica como para poder justificar una exploración cervical selectiva sobre la base de los hallazgos que proporciona. En el hiperparatiroidismo secundario la prueba es poco fiable. (AU)

Reflections on the process of auditing myocardial infarction.

The publication of the National Service Framework for Coronary Heart Disease has meant that audit is becoming an increasingly important part of cardiac healthcare provision in England. Comparisons between hospitals will be made so it is essential that the audit data is as robust as possible. Nurses often play a key role in the collection of such data. This article reflects on this process, with particular reference to thrombolysis in acute myocardial infarction. Topics discussed include eligibility, the role of a clinician, electrocardiogram interpretation, justified delays, inappropriate and "missed" administration. As some of the information is, arguably, open to interpretation, the authors believe that clinical auditors will inevitably have to grapple with such clinical definitions and their implications.