Double tract reconstruction (DTR) - an alternative type of digestive tract reconstructive procedure after total gastrectomy - own experience.

UNLABELLED: The only proven, effective therapy in case of the gastric cancers is surgery. THE AIM OF THE STUDY: The most common procedure which is made in such a situation is total resection of the stomach. In our publication we would like to present and to recommend a very rare made type of the reconstructive procedures after total gastrectomy, which is called "double tract reconstruction" (DTR). This type of reconstruction is occasionally made mainly in Japan.Material and methods. Double tract reconstruction has been made in 2nd Department of General and Gastroenterological Surgery since 2000. Till today 75 patients were treated with this method. RESULTS: The frequency of complications after double tract reconstruction was occasional, and there were no differences between this procedure and Roux-en-Y method of the reconstruction. There were no differences in the time of the operation between this two methods. The most important advantage of this method is that duodenal passage is extant. Because of that the endoscopic examination of papilla Vateri can be made. CONCLUSIONS: We would like to recommend this method as an alternative to Roux-en-Y procedure because of its simplicity and safeness.

IGF-IR in patients with advanced colorectal cancer in correlation with certain clinico-morphological factors: Initial report.

The insulin-like growth factor (IGF) system comprises two types of peptides (IGF-I and IGF-II), two types of receptors (IGF-IR and IGF-IIR) and six IGF-binding proteins (BP). This system is mainly responsible for the growth and division of cells in the body, regulation of the cell cycle and prevention of apoptosis. The expression of IGF-IR was assessed in the cells of resected primary colorectal tumours in 88 patients (age, 36-87 years; mean 64.78; males, 48 and females, 40) treated surgically at the Second Department of General and Gastroenterological Surgery, Medical University of Bialystok, Poland, in relation to various clinico-morphological factors. The post-operative material was analysed to find the histological type, location of lesions, lymph node involvement staging, distant metastases (pTNM classification), staging in Dukes' classification and the histopathological differentiation grade. The expression of IGF-IR in colorectal cancer cells was assessed using an immunohistochemical method. The findings were subjected to statistical analysis (Chi-square test, multivariation test and Mann-Whitney U test). A positive IGF-IR expression (in at least 10% of cancer cells) was observed in 44 patients. The mean immunoreactive cell count for IGF-IR in all of the tumours studied was 30.79%. The current study showed no correlation of IGF-IR expression in colorectal cancer cells with characteristics such as age and gender of patients, tumour location, type, histological differentiation or histopathological advancement. Immunohistological determination of IGF-IR expression in advanced colorectal cancer cells revealed controversial scores. Evaluation should be confirmed by using other methods and enhanced to include adenomas and early colorectal cancers.

Comprehensive medical care for victims of sexual assault: a survey of Illinois hospital emergency departments.

BACKGROUND: Sexual assault is a major public health problem affecting 17 million women in the United States. Hospital emergency departments (EDs) are often the primary point of care for these women. We propose the concept of "comprehensive medical care management" (CMCM) at the primary point of care for victims of sexual assault. The objectives of this study were (a) to describe medical care services provided to sexual assault victims presenting at the EDs in Illinois hospitals, and (b) to identify the percentage of hospitals that always provide all 10 elements of CMCM. STUDY DESIGN: This is a cross-sectional prevalence study. A 14-item phone survey was administered to 187 eligible EDs in Illinois from July to September 2004. Outcome measures were the percentages of EDs that provide the elements of CMCM: (a) acute medical care; (b) history and physical exam; (c and d) acute and long-term rape crisis counseling; (e and f) prophylactic and therapeutic sexually transmitted infection (STI) management; (g and h) prophylactic and therapeutic HIV management; and (i and j) counseling and provision of emergency contraception. RESULTS: An 83% response rate of eligible emergency rooms provided the following data: while 100% of emergency rooms provide acute medical care upon presentation, two thirds provide rape crises counseling, two thirds provide STI management, 4 of 10 report counseling and provision of emergency contraceptives, and only 28.2% provide HIV management. About 1 in 10 (9.6%) provides all elements of CMCM. CONCLUSION: Although there are recommendations from various medical organizations for all 10 elements of CMCM for victims of sexual assault, very few hospitals provide CMCM. Improvements must be made to provide quality comprehensive care for victims of sexual assault.

Activity of cathepsin B and D in colorectal cancer: relationships with tumour budding.

UNLABELLED: It has been reported that poorly-differentiated clusters of cancer cells at the invasive front, namely "tumour budding", may reflect malignancy of colorectal cancer. The aim of the present study was to evaluate the activity of cathepsin D and B in tumours and in normal mucosa from pT3 and G2 colorectal cancers, and to analyse their association with tumour budding at the invasion front of colorectal cancer. PATIENTS AND METHODS: A total of 40 patients classified as pT3, G2 underwent curative resection of colon cancer between 1997 and 2001. The fragments of tumours and normal colorectal tissue were obtained for biochemical examinations. We also categorized tumour budding (TB) at the front of invasion. Two groups were used for classification of the TB phenomenon: the first where no bud was observed- TB(-), and the second where at least one bud was found -TB(+) at the front of invasion in the examined slice. RESULTS: The activity of cathepsins D and B was found to be statistically significantly higher both in the neoplastic tissue cytosol and homogenate, compared to the cytosol and homogenate of adjacent healthy tissue (p<0.05). There was, however, no significant difference between tumour budding and the activity of cathepsin D in tumour tissue, but we found a statistically significant difference between the activity of cathepsin B in the homogenate and cytosol of tumour tissue and budding-positive tumours (p=0.027, p=0.004, respectively). CONCLUSION: These results suggest that the activity of cathepsin D is not involved in tumour budding. In our opinion, much more attention should be paid to cathepsin B, as a potentially responsible factor in tumour progression, since it strongly increased with the presence of tumour budding.

Evaluation of K-RAS gene in colorectal cancer.

The aim of the study was to assess the prevalence of K-RAS gene mutations in colorectal cancer and their role in diagnosis and prognosis. The study involved 36 patients with colorectal cancer at different stages of the disease progression and with different histopathologic grading. Mutations of codon 12 of K-RAS gene investigated using PCR-RFLP technique were found in 15 patients (41.67%). Although no statistically significant correlation was observed between the disease progression, histopathologic findings, gender and age, we suppose that assessment of K-RAS gene mutations might be of clinical value in the prognosis of colorectal cancer.

Does colorectal cancer influence platelet activation?

Many investigators have given evidence that platelets play a significant role in tumour growth and neoplastic metastases. On the other hand, neoplastic cells of various tissues are capable of platelet activation. The aim of the present study was to evaluate platelet activation in 26 patients with colorectal cancer (CRC) in relation to clinical advancement and surgical treatment. beta-thromboglobulin concentration was determined using the ELISA assay and PLT count was evaluated with Technicon H3 System. Blood for BTG concentrations was collected three times--before surgery (A0), three days (A1) and twelve days (A2) after surgery. Results show that patients with CRC have a significantly higher BTG concentration in all groups (A0, A1, A2) versus control group (C). There was no significantly differences in BTG concentration between patients with metastases and without metastases to lymph nodes and distant organs. Our investigations confirm platelet activation in the course of colorectal cancer irrespective of clinical advancement. Surgical treatment applied in these patients significantly affects morphological and functional parameters of blood platelets.

[Selected hematopoietic cytokines in patients with colorectal cancer]. / Wybrane cytokiny hematopoetyczne w surowicy chorych na gruczolakoraka jelita grubego.

We have investigated the serum level of selected hematopoietic cytokines, such as interleukin 3, granulocyte-macrophage--colony stimulating factor (GM-CSF), granulocyte--colony stimulating factor (G-CSF) and macrophage--colony stimulating factor (M-CSF) in colorectal cancer patients. Also correlations between their concentrations and stages were made. The study was done on group consisted of 30 diagnosed colorectal cancer patients. The used classification of stage of the tumor was described by Dukes. The results were compared with control group consisted of 20 healthy persons. The examined factors were assayed by ELISA method. In colorectal cancer patients the serum levels of IL-3, GM-CSF and M-CSF were increased in comparison with the control group. The differences between cytokines concentrations in control group and colorectal cancer patients were statistically significant for GM-CSF and M-CSF. The serum levels of cytokines were higher in more advanced tumor stage. This results permit for further study on usefulness of these cytokines as a markers for colorectal cancer.

Positive changes among very low birth weight infant Apgar scores that are associated with the Neonatal Resuscitation Program in Illinois.

OBJECTIVE: The American Academy of Pediatrics and American Heart Association sponsored Neonatal Resuscitation Program (NRP) was started in Illinois 1987 to standardize knowledge and skills for successful resuscitation to decrease newborn morbidity and mortality. This study evaluated the hypothesis that the statewide NRP in Illinois hospitals was associated with positive outcomes in the Apgar scores among very low birth weight newborns. STUDY DESIGN: A retrospective design was used to compare the (a) different rates of lower (0-6) and higher (7-10) 1- and 5-minute Apgar scores and (b) positive change from a lower 1-minute to a higher 5-minute Apgar score before and after NRP was started. Analyses included maternal characteristics, birth weight groups (grams: 500-749, 750-999, 1000-1249, 1250-1499), and hospital levels (I, II, III). RESULTS: A significantly higher proportion of infants had a higher 1-minute and a higher 5-minute Apgar score after NRP, overall, for Level II and II+ hospitals and for each weight group. Logistic regression indicated that newborns with low 1-minute Apgar scores were 81% more likely to have a higher 5-minute Apgar score after NRP. CONCLUSION: Significant improvement in Apgar score occurred after NRP. Empirical support is demonstrated for the clinical effectiveness of NRP instruction in Illinois hospitals.

Maternal and Paternal Risk Factors and Birth Outcomes among Asian and Pacific Islanders in Illinois.

PURPOSE. The pupose of this study was to compare maternal and paternal risk factors and the outcomes of Asian Pacific Islander (API) pregnancies with other racial/ethnic groups (Black, Hispanic, and White) in Illinois. METHODS. We examined computerized birth certificate files in Illinois to descriptively analyze birth outcomes and parental characteristics for births occurring between 1989 and 1993. Infant mortality tables were examined for birth cohorts born from 1989 to 1992. Rates among Illinois API groups were presented for the following: maternal and paternal socio-demographic factors; maternal medical risk factors, amount of prenatal care and type of method of delivery; newborn complications and various morbidity outcomes; and, early neonatal mortality. For comparison, simliar Illinois data are presented for Blacks and Whites and Hispanics. We statistically evaluated the significance in variability of rates. PRINCIPAL FINDINGS. APIs in Illinois experienced a lower infant mortality rate. API mothers were more likely to be married, beyond the teenage years, have more education and smoke less often during their pregnancy than any of the other racial/ethnic groups. In addition, API mothers were more likely to experience primiparity rather than high parity. We detected statistically signifacnt differences for maternal and paternal socio-demographic characteristics among the four populations (p<0.0001). Similarly we found statistically significant differences in risk factors during pregnancy and labor and delivery complications among four race/ethnic population (p<0.0001). CONCLUSIONS. Fetal, neonatal, post-natal and infant mortality rates were the lowest among APIs when compared to Hispanic, Black and White neonates. These differences were statistically signifacant. However, rates of inadequate prenatal care, labor and elivery complications, prematurity and low birth weight were not similarly lower among APIs. RELEVANCE TO ASIAN AND PACIFIC ISLANDER AMERICAN POPULATIONS. This paper provides a state-level examination of parental risk factors and birth outcomes among APIs. KEY WORDS. infant mortality rates; pregnancy outcomes; prenatal care; maternal risk factors; paternal risk factors; women; Illinois.