Peritoneal microdialysis. Early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer.

BACKGROUND: The aim of the present study was to evaluate the efficacy and safety of intraperitoneal microdialysis in early detection of anastomotic leakage after low anterior resection for rectosigmoid cancer. METHODS: In a series of 116 consecutive patients scheduled for low anterior resection for rectosigmoid cancer, a total of 50 patients consented to participate. Peritoneal microdialysis was performed by a 1 mm thin catheter anchored in close proximity to the anastomosis. Five patients were excluded due to catheter malfunction. Average microdialysis time in the remaining 45 patients was 177.6 (80-252) hours. Samples were collected every 4-hours, and the concentration of glucose, lactate, pyruvate and glycerol was measured. RESULTS: Four patients developed symptomatic anastomotic leakage. Two patients developed non-abdominal sepsis. In 38 patients the postoperative course was uncomplicated, considering major complications, and they served as controls. In three patients with late (>or=10 days) anastomotic leakage a significant increase in concentration of lactate and lactate/pyruvate ratio (L/P-ratio) was seen several days prior to development of clinical symptoms. In one patient with early anastomotic leakage it coincided with the development of clinical symptoms. In the two patients with non-abdominal sepsis the values were within normal range. CONCLUSION: Peritoneal microdialysis is a safe and promising tool in early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer.

Pregnant women's perceptions of abuse.

OBJECTIVE: To determine whether pregnant women's perceptions of abuse severity and danger, and their ability to control the abuse, are significantly correlated with the acts of abuse they experience, and to find out whether relationships exist among women's appraisals of abuse severity, danger, and their perceived ability to stop the abuse. DESIGN: A correlational design was used to compare the abusive acts experienced by the women and their perceptions of that abuse. SETTING: Nine prenatal clinics in urban areas of the northeastern United States. PARTICIPANTS: Sixty-one ethnically diverse, pregnant abused women were interviewed. MAIN OUTCOME MEASURE: Pearson's product-moment correlations were used to examine relationships between abusive experiences and women's perceptions of abuse. RESULTS: Women's perceptions of abuse severity were modestly correlated with threatened (r = .25) and actual violence (r = .36). Perceptions of abuse severity and danger were correlated (r = .41). CONCLUSIONS: Women's beliefs about abuse severity, danger, and their ability to control abuse cannot be fully comprehended by exploring the discrete acts they experience. Further research is needed to identify additional factors that influence those beliefs.

Screening for abuse: barriers and opportunities.

Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant women's psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.

Insulin antibodies induced by bovine insulin therapy.

Insulin antibodies are detectable in the sera of most patients within 3-4 months of starting treatment with conventional bovine insulins. Various factors determine the immunogenicity of insulin preparations including the genetic background of the recipient. This causes wide variation in response. Solid phase absorption studies as well as competitive binding in fluid phase indicate that the antibodies formed are almost always specific for determinants shared by the endogenous human molecule. This has important implications for the metabolic effect of insulin antibodies in vivo as well as for mechanisms of autoantibody production in man.

An immunochemical method for the quantitation of insulin antibodies.

A 125I-labelled insulin binding assay is described in which IgG antibody is precipitated by the addition of an optimal concentration of second antibody. Other features include the removal of unlabelled insulin from test sera prior to assay and the use of 22Na as a volume marker. This approach overcomes problems associated with previous assays for insulin antibodies. Clear differences are seen in the IgG insulin binding capacity (IBC) of sera from patients with insulin resistance and injection site lipo-atrophy when compared with insulin-treated diabetics who lack such complications. The precision and flexibility of this technique make it particularly suitable for studies of the immune response to different species and forms of insulin.

[Lymphogenic metastasis in prostate carcinoma and radiation therapy]. / Lymphogene Metastasierung beim Prostatakarzinom und Strahlentherapie.

Our examinations allow the following conclusions: 1. Before the beginning of a curative radiotherapy of the carcinoma of the prostate gland in a negative and questionably positive lymphogramme the pelvic lymphadenectomy with histologic examination of the lymph nodes is indicated. 2. In the negative findings of the histologically examined lymph nodes an exclusive local tumour irradiation is justified. 3. If in regional and negative findings micrometastases appear in the area of juxtaregional lymph nodes the additional curative irradiation of the pelvic lymph nodes seems to be indicated for the comprehension of the regional lymph nodes. 4. When there are micrometastases in the area of the aa. iliacae communes or macroscopically extended metastases in the regional and juxtaregional lymph area, so we regard as a rule a radiotherapy of the carcinoma of the prostate gland no more indicated and recommend a contrasexual treatment. The necessary expansion of the radiotherapy is according to our hitherto existing experiences badly tolerated by the for the most part older patients. 5. The intraoperative labelling of the prostate gland and the determination of the size of the prostate gland facilitate the localisation of the tumour for the radiotherapist.

The assessment of antichymotrypsin in cancer monitoring.

A comparative study of serum antichymotrypsin, acid glycoprotein and antitrypsin levels has been made in various cancers. Antichymotrypsin (ACT) shows a non-specific elevation in metastatic cancer, and the response reflects tumour progression in a similar fashion to the other two acute phase reactant proteins. The main advantage of ACT as a marker appears to be its Normal distribution in health, and lack of phenotypic variation.