Individual invitation letters lead to significant increase in attendance for screening colonoscopies: Results of a pilot study in Northern Hesse, Germany.

BACKGROUND: Colorectal cancer (CRC) is the second most common cancer in Germany. Screening colonoscopies are considered an effective tool for early detection and prevention of CRC and are recommended in Germany for citizens over the age of 55. To increase the participation rate for screening colonoscopies, an invitation procedure was initiated in parts of Germany for patients between the ages of 55 and 75 who had never undergone a screening colonoscopy before. METHODS: We examined the number of participating patients before, during, and after the invitation procedure and compared the number of the participating patients who received a cover letter with the participating patients from the control group. Additionally, we classified the findings of the colonoscopies including CRC, advanced adenomas, and polyps. RESULTS: During the invitation period, the participation rate of the invitation group increased from 220 patients to 531 patients compared to 1256 to 1693 in the control group. The increase was significantly greater in patients with cover letters (+141% vs.+35%, p < 0.0001). Also, significantly more polyps and adenomas were found in patients from the invitation letter group (254 (+102%) vs. 679 (-9%), p < 0.0001). CONCLUSIONS: Our study clearly indicates that personal invitation letters are an effective measure to increase overall participation rates in screening colonoscopies.

[Sonographic course of alcoholic fatty liver by interobserver and digital evaluation of liver echogenicity]. / Sonografische Verlaufsbeurteilung der alkoholischen Fettleber durch untersucherbezogene und digitale Analyse der Echogenität des Binnenreflexmusters.

BACKGROUND: The reversibility of alcoholic fatty liver is well-known. The present study aims to investigate whether sonographic controls can document this reversibility under abstinence therapy with respect to inter-observer variability. METHODS: 59 male patients with alcohol dependency were examined by ultrasound at the beginning and the end of a long-term in-patient withdrawal therapy. Fatty liver was graded qualitatively (no, slight, moderate and severe fatty liver). The sonographic liver sections were registered digitally per examination and were subsequently evaluated by means of the PC by two independent experts. Additionally, a digital texture analysis of representative hepatic and renal regions was performed. The pixel intensity ratio of liver and kidney was used as a measure of liver echogenicity. RESULTS: In the ultrasound examination, the 59 patients had the following severity grade of fatty liver initially: 18 (31 %) severe, 19 (32 %) moderate, 22 (37 %) slight. 37 patients (63 %) showed sonographically an improvement of the initial severity grade within 79 +/- 26 days (p < 0.0001, 95 % confidence interval: 50 - 74 %). The evaluation by the independent experts revealed 47 and 54 % improvement, respectively. The overall degree of agreement between the 3 ratings concerning grading and course was high (intraclass coefficient = 0.896). However, there was a marked deviation between the several grading levels (agreement 15 - 86 %). The categorical differentiation between no/slight versus moderate/severe fatty liver revealed an agreement of between 81 and 91 %. The mean pixel intensity ratio showed an improvement of 17 % (p < 0.0001). CONCLUSIONS: After 3 months abstinence an improvement of alcoholic fatty liver can be consistently documented in about 50 % of the cases by sonography. The interobserver variability on differentiating no/slight versus moderate/severe fatty liver was low. The digital texture analysis confirmed the range of reversibility and could play a role in quantifying the sonographic degree of fatty infiltration.

Haemodynamic quantification of different provocation manoeuvres by simultaneous measurement of right and left atrial pressure: implications for the echocardiographic detection of persistent foramen ovale.

AIMS: Persistent foramen ovale (PFO) is found in 9.2--32% of echocardiographic examinations. The gold standard for the detection of a PFO is transoesophageal echocardiography (TEE) and the mostly used provocation test is the Valsalva manoeuvre. The aim of our study was to evaluate the effectiveness of the Valsalva manoeuvre compared to other provocation tests by simultaneous haemodynamic measurements of the right and left atrial pressure. METHODS: Fifty patients underwent Swan-Ganz catheterization. Right atrial pressure and pulmonary capillary wedge pressure, which corresponds to the left atrial pressure, were measured simultaneously. The following manoeuvres were compared: the Valsalva manoeuvre, coughing, deep inspiration and expiration pressures of 20 mmHg, 40 mmHg and 60 mmHg. The main objective of our study was to compare the occurrence of pressure gradients (right atrial pressure> left atrial pressure). For further quantification mean gradients, time duration of pressure overlap, as well as products of mean gradients and overlap time were analysed. RESULTS: During the Valsalva manoeuvre a significant pressure gradient could be observed in 84% of the patients, followed by an expiration pressure of 60 mmHg (82%), inspiration (78%), expiration pressure of 40 mmHg (76%), coughing (75%) and an expiration pressure of 20 mmHg (62%). Comparing the mean gradients and the products of mean gradients and overlap time duration during the different manoeuvres, we could detect the significantly best results with the Valsalva manoeuvre. CONCLUSIONS: The Valsalva manoeuvre might be the most effective test to provoke a right-to-left atrial shunt for the detection of a PFO during echocardiographic examinations.

[The skin prick test and nasal provocation test with individually prepared flour extracts in patients with bakers' rhinitis and asthma]. / Prick-Test und nasaler Provokationstest mit individuellen Mehlextrakten bei Bäckerrhinitis.

The reliability of skin prick tests (SPT) may be insufficient for the screening of occupational inhalant allergies. The influence of different flour extracts on the SPT in flour allergic subjects has not been compared previously. In this study, SPT reactions against two commercially available rye and wheat flour extracts and individually prepared extracts from flour samples were compared in 35 patients with known bakers' rhinitis. Flour sensitization was confirmed by a positive nasal provocation test (NPT) and/or serum-specific IgE. The sensitivity of NPT with a combination of rye and wheat flour extracts of individual flour samples was 94%. Wheat and/or rye flour specific IgE (RAST>/=2) was true positive in 86%. The sensitivity of the SPT was 94% for individual rye flour extracts compared to 38% and 59% for two commercially available rye flour extracts and 88% for individual wheat flour extract compared to 53% and 48% for commercially available wheat flour extracts. SPT and sIgE did not reveal a significant difference in prevalence between rye and wheat flour sensitization. Thirty healthy volunteers served as the control group. Three control subjects with histamine equivalent SPT reactions to grass pollen had a positive SPT reaction against individual flour extracts, whereas NPT with undiluted individual flour extracts was negative in all controls. SPT with individually prepared flour extracts appears to be sensitive for the demonstration of inhalant flour allergy. Our findings show that extracts of individual flour samples rather than commercially available extracts should be used for both SPT and NPT if flour allergy is suspected.

Evaluation and validation of a Crohn's disease inflammatory activity index reflecting pattern of endoscopic severity.

BACKGROUND: This study was designed to investigate objective variables assessing the inflammatory activity of Crohn's disease accessible for routine management and their suitability to act as surrogate indicators for endoscopic alterations. METHODS: Thirty-six patients were included in a prospective study and underwent endoscopic investigation, 18 with clinically exacerbated disease and 18 after acute-phase conservative therapy. The endoscopic findings were classified to define the dependent variable, yielding two categoric levels: acute active disease and remission. The extent of affected mucosal area was not taken into consideration. The serum variables alpha1-antitrypsin, acid alpha1-glycoprotein (AGP), C-reactive protein (CRP), sialic acids, prealbumin (PAB), and albumin were used as independent variables to predict the dependent variable. To compare the results with common indices, the Crohn's Disease Activity Index (CDAI) and van Hees Index were calculated. RESULTS: The following model was calculated by stepwise logistic regression analysis: if AGP (mg/dl) -4.2 x PAB (mg/dl) > or =0.8, then endoscopically active disease will be predicted with a sensitivity of 100% and a specificity of 95% (P < 0.001). The predictive values of the single variables, CDAI, and van Hees Index were lower. For validation of results an analogous study was performed including 44 patients, 29 with active disease and 15 controls. The existence of the model was confirmed, again showing high values for sensitivity (86%) and specificity (100%). CONCLUSIONS: On a qualitative level focusing on clinical relevance, the endoscopic and biologic findings of Crohn's disease are highly associated. In addition to clinical assessment, usage of the developed index as a rationale contributing to therapeutic decisions in the short- and long-term management might be reasonable.

[Value of dipyridamole-atropine stress echocardiography for detection of patients with restenosis after PTCA]. / Wertigkeit der Dipyridamol-Atropin-Stressechokardiographie für die Erkennung von Patienten mit Restenosen nach PTCA.

UNLABELLED: Stress-Echocardiography has been proven to be a valuable method in the diagnosis of patients with suspected coronary artery disease. It has been demonstrated that the addition of atropine can increase the sensitivity of pharmacological stress-echocardiography-tests. The aim of our study was to evaluate the diagnostic potential of dipyridamole-atropine-echocardiography for the detection of restenosis after coronary angioplasty. We investigated 50 patients 3-6 months after primary successful coronary angioplasty. Restenosis was defined as recurrence of stenosis of > or = 70% at the site of dilatation determined by quantitative coronary angiography. All patients were investigated on antianginal medication and underwent control-coronary angiography within 1-3 days after the echocardiographic study. In 17/23 patients with restenosis, the dipyridamole-atropine-stress-test was pathologic (sensitivity 74%), in 25/27 patients without significant restenosis the echocardiography stress-test was normal (specificity 93%). In 6 patients with restenosis and an unsuspicious stress-test, the percent diameter of restenosis did not exceed > or = 90% lumen narrowing, restenosis of the LAD was correctly identified in all patients (n = 11). The diagnostic accuracy of the dipyridamole-atropine-stress-test for the detection of patients with restenosis after PTCA in our study was 84%, the positive predictive value of a pathologic echocardiography stress-test for the detection of significant restenosis was 89%, the negative predictive value was 81%. CONCLUSIONS: Dipyridamole-atropine-echocardiography has diagnostic potential for non-invasive assessment of patients after coronary angioplasty. In patients with a normal echocardiographic stress-test, the probability of significant restenosis is considerably low, even if restenosis cannot be definitely excluded.

HLA-DQ1 is associated with clinical response and survival of patients with melanoma who are treated with interleukin-2.

AIM: The risk of developing melanoma, the natural history of this disease, and the response to therapy with biological reagents may be determined, in part, by a patient's human leukocyte antigen (HLA) phenotype. In order to study this, the relationship between HLA type and clinical response to therapy with interleukin-2 (IL-2) was evaluated. METHODS: We retrospectively determined the HLA phenotype of 82 patients with metastatic melanoma who were treated with IL-2-based therapy. Fresh or frozen lymphocytes were serologically typed by standard lymphocytotoxicity techniques (NIH or Amos modified). The treatment regimens included IL-2 alone or with tumour infiltrating lymphocytes, lymphokine activated killer cells, cyclophosphamide, interferon-alpha, and tumour necrosis factor-alpha. Initially, the relationship between clinical response and each HLA antigen was evaluated by performing a two-tailed Fisher exact test. Associations with a P-value less than or equal to 0.10 without adjustment for multiple comparisons were considered worthy of further study. Independent confirmation of these apparent associations was obtained by studying the relationship between HLA phenotype and patient survival using Cox proportional hazards models. RESULTS: In the initial screening, a statistically significant association between clinical response and the expression of HLA-DQ1 was observed (unadjusted P2 = 0.0017). HLA-DQ1 was also independently associated with prolonged survival (P2 = 0.026). This positive association with survival was evident both for patients who responded to therapy and those who did not respond, as defined by > 50% tumour regression. CONCLUSIONS: Among patients with metastatic melanoma, HLA-DQ1 appears to be associated with clinical response to therapy using IL-2. This apparent association is confirmed by the observation that HLA-DQ1 is independently associated with prolonged survival in this group of patients.