Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases.

BACKGROUND: The management of patients with colorectal cancer and simultaneously diagnosed liver and lung metastases (SLLM) remains controversial. METHODS: The LiverMetSurvey registry was interrogated for patients treated between 2000 and 2012 to assess outcomes after resection of SLLM, and the factors associated with survival. SLLM was defined as liver and lung metastases diagnosed 3 months or less apart. Survival was compared between patients with resected isolated liver metastases (group 1, control), those with resected liver and lung metastases (group 2), and patients with resected liver metastases and unresected (or unresectable) lung metastases (group 3). An Akaike test was used to select variables for assessment of survival adjusted for confounding variables. RESULTS: Group 1 (isolated liver metastases, hepatic resection alone) included 9185 patients, group 2 (resection of liver and lung metastases) 149 patients, and group 3 (resection of liver metastases, no resection of lung metastases) 285 patients. Ten variables differed significantly between groups and seven were included in the model for adjusted survival (age, number of liver metastases, synchronicity of liver metastases with primary tumour, carcinoembryonic antigen level, node status of the primary tumour, initial resectability of liver metastases and inclusion in group 3). Adjusted overall 5-year survival was similar for groups 1 and 2 (51·5 and 44·5 per cent respectively), but worse for group 3 (14·3 per cent) (P = 0·001). CONCLUSION: Patients who had resection of liver and lung metastases had similar overall survival to those who had undergone removal of isolated liver metastases.

Impact of lifestyle intervention on body weight and the metabolic syndrome in home-care providers.

AIM: The study evaluated the impact of lifestyle intervention on body weight, metabolic syndrome parameters, nutrition and physical activity in home-care providers (HCPs). METHODS: Of 551 screened employees of a nursing agency, 173 were eligible to participate and were assigned to either the intervention (n=129) or the control (n=44) group. Participants in the intervention group followed an educational programme that encouraged physical activity and healthy nutrition, and were equipped with bicycles free of charge. Anthropometric, biological and lifestyle parameters were assessed at baseline, and after 6 and 12 months. RESULTS: Body weight, waist circumference and systolic blood pressure significantly decreased at 12 months in both study groups. Incidence of the metabolic syndrome in the intervention group at 12 months was reduced by 50% (from 17 to 9.2%; P=0.04). There were also decreases in LDL cholesterol (-0.36 mmol/L; P<0.01), total cholesterol/HDL cholesterol ratio (-0.57; P<0.01) and fasting glucose (-0.4 mmol/L; P<0.05), and an increase in HDL cholesterol (+0.22 mmol/L; P<0.01) in the intervention group. At 12 months, a decrease in daily caloric intake (-391 kcal/day; P<0.001) and an increase in the percentage of participants engaging in physical activity (+3.4%; P<0.05) were also observed in the intervention group. CONCLUSION: Lifestyle changes among HCPs are possible with relatively modest behavioural education and within a short period of time. Educational strategies and workshops are effective, efficient and easy to perform, and should be encouraged in HCPs to promote the implementation of lifestyle modifications in their patients.

Is atrial fibrillation associated with pulmonary embolism?

BACKGROUND: A pulmonary embolism (PE) is thought to be associated with atrial fibrillation (AF). Nevertheless, this association is based on weak data. OBJECTIVES: To assess whether the presence of AF influences the clinical probability of PE in a cohort of patients with suspected PE and to confirm the association between PE and AF. PATIENTS/METHODS: We retrospectively analyzed the data from two trials that included 2449 consecutive patients admitted for a clinically suspected PE. An electrocardiography (ECG) was systematically performed and a PE was diagnosed by computer tomography (CT). The prevalence of AF among patients with or without a PE was compared in a multivariate logistic regression model. RESULTS: The prevalence of PE was 22.8% (519/2272) in patients without AF and 18.8% (25/133) in patients with AF (P = 0.28). After adjustment for confounding factors, AF did not significantly modify the probability of PE (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.42-1.11). However, when PE suspicion was based on new-onset dyspnea, AF significantly decreased the probability of PE (OR 0.47, 95% CI 0.26-0.84). If isolated chest pain without dyspnea was the presenting complaint, AF tended to increase the probability of PE (OR 2.42, 95% CI 0.97-6.07). CONCLUSIONS: Overall, the presence of AF does not increase the probability of PE when this diagnosis is suspected. Nevertheless, when PE suspicion is based on new-onset dyspnea, AF significantly decreases the probability of PE, as AF may mimic its clinical presentation. However, in patients with chest pain alone, AF tends to increase PE probability.

[Biomarkers in acute kidney injury: an update]. / Biomarqueurs dans l'insuffisance rénale aiguë.

Acute kidney injury is associated with higher risk of chronic kidney disease or death. Diagnosis is based on increased serum creatinin, most often several days after the initial renal injury. Several novel biomarkers are being studied and validated in clinical settings. Cystatin C, NGAL, KIM-1, IL-18 or L-FABP are the most promising. Their elevation in serum or urine is specifically associated with kidney injury. They seem also to predict mortality and the need of dialysis. In the near future, these biomarkers could affect the way we treat patients with acute kidney injury, as well as their evolution. However, the real challenge will be in using the best combination of biomarkers and in the correct interpretation of their results.

[Update in hospital medicine 2008]. / Médecine interne hospitalière.

This paper summarizes several important studies published during the previous year that have an impact on the practice of inpatient internal medicine, because they either modify or reinforce current practices. The selected domains include cardiovascular disease, for example the management of hypertension in very old patients, the effects of blockade of the renin-angiotensin-aldosterone system, and the use of biomarkers in cardiology; neurovascular pathology, specifically the prognosis of transient ischemic attacks and some aspects of cardioembolic stroke due to atrial fibrillation. Other topics include pneumonia prognosis, the management of ascitis fluid or of septic shock, and methodology.

Antibiotic use: is appropriateness expensive?

Antibiotics are prone to misuse. In this study, 37% of 600 antibiotic prescriptions in three hospitals were considered unnecessary. When antibiotic therapy was indicated, 45% were considered to be inadequate. In multivariate analyses, the indicated treatments were found to be more expensive than the unjustified ones, probably because the latter were more often oral regimens. However, for indicated treatments, the cost of adequate and inadequate treatments did not differ significantly.

The relative validity of a chronological drinking record.

The results of chronological and a daily drinking record are compared. The chronological record was completed by interviewers who probed for information on all drinking episodes during the last week. The daily record covered only the last day and was completed by the respondent without interviewer assistance. Because of the recency of the information, the daily record was expected to yield the more valid results, but this hypothesis was not supported by the findings. Total alcohol consumption reported by the chronological method was significantly higher because men, but not women, reported fewer drinking episodes with the daily record for the same period. Daily recording may have placed too heavy a burden on the most frequent drinkers, most of whom were men.

The reliability of drinking estimates obtained with two data collection methods.

Two data collection methods, weekly interview and daily record, obtained equally reliable estimates of alcohol consumption per event, but weekly interviews obtained more reliable estimates of the number of drinking events and the amount of alcohol consumed over a 2-week or longer period.

Social activity and drinking patterns.

This paper reports data on the relationship between social activity and daily alcohol consumption in a random sample of adults in metropolitan Boston. The findings indicate that the frequency of going to bars and attending parties was significantly related to daily alcohol consumption.