Influence of BMI on short-term surgical outcome after colorectal cancer surgery: a study based on the Swedish national quality registry.

PURPOSE: It is well known that an increased body mass index (BMI) is associated with cancer development. Results from studies on colorectal cancer (CRC) treatment outcome and BMI are however conflicting. Our hypothesis was that a high as well as a low BMI will have negative effects on short-term outcome after CRC surgery. METHODS: Data from the Swedish Colorectal Cancer Registry from 2007 to 2012 was analyzed. A total of 24,587 patients operated on for CRC were included in the study and divided into one of five categories for BMI. Operative bleeding, operating time, surgical complications, and 30-day mortality were compared between groups. RESULTS: Operative bleeding as well as operating time was significantly increased when comparing normal-weight patients to overweight (p < 0.001). 15.1% of normal-weight patients suffered from postoperative surgical complications. This was significantly increased with each BMI step but did not affect the 30-day mortality. However, underweight patients, on the other hand, had fewer complications (13.3%) but an increased 30-day mortality. CONCLUSION: Longer operating times and increased perioperative bleeding may be explanatory factors behind increased postoperative complication rates for CRC patients with higher BMI. In underweight patients, advanced disease may be a reason for a higher 30-day mortality. To improve outcome, specific precautions are suggested when operating on under- as well as overweight CRC patients. We also suggest that the registry introduces a better marker than BMI for central visceral fat-the link between obesity and cancer development. Further studies are needed to analyze the findings in detail and to study long-term effects.

S-100B in serum and urine after traumatic head injury in children.

BACKGROUND: Children with head trauma are frequently seen in many emergency units. The clinical evaluation of these patients is difficult for a number of reasons and improved diagnostic tools are needed. S-100B, a protein found in glial cells, has previously been shown to be a sensible marker for brain damage after head injury in adults, but few studies have focused on its use in children. METHODS: In this study, 111 children with head trauma were included and venous blood and urine samples were taken at arrival (S1 and U1) and 6 hours later (S2 and U2). S-100B levels were analyzed. Clinical and radiologic evaluations were performed according to hospital routine. Two groups were identified- group 1: no computed tomography (CT) scan performed ora CT scan without any sign of trauma-related intracranial pathology (n = 105). Group 2: A CT scan with signs of trauma-related intracranial pathology (n = 6). RESULTS: In group 1, the median (inter quartile range) serum S-100B value in S1-samples was 0.111 microg/L (0.086-0.153), and in group 2, it was 0.282 microg/L (0.195-1.44) (p < 0.01). Also, S2 values significantly differed between the two groups. Urine values were, however, not significantly differing between the groups. CONCLUSIONS: Serum S-100B values within 6 hours after head trauma in children were significantly higher in patients with intracranial pathology compared with those without intracranial complications. Identification of these high-risk patients already in the emergency department is of major importance, and we suggest that S-100B could be a valuable diagnostic tool in addition to those used in clinical practice today.

A comparison of two different assays for determining S-100B in serum and urine.

BACKGROUND: Brain injury after head trauma can be detected by S-100B measurements in serum. Recent preliminary studies indicate that urinary levels of S-100B are also increased after head injury, a finding that is of possible clinical value. The aims of the present study are two-fold: to compare serum measurements of two assays, the Liaison Sangtec 100 system and the Elecsys S100 test, and to investigate to what extent they can detect and measure S-100B in urine. METHODS: A total of 191 serum and 174 urine samples from 107 patients (children aged between 1 and 18 years following head trauma) were measured with both assays. The results were compared using correlation analysis and Bland-Altman difference plots. RESULTS: Serum values of the Sangtec system ranged from 0.02 to 2.28 microg/L, and from 0.005 to 2.13 microg/L for the Elecsys test. Comparisons showed a clear correlation (correlation coefficient 0.80) but not an agreement between the methods. The Sangtec system could only detect S-100B in 20 out of 174 urine samples (range 0.02-0.06 microg/L), whereas the Elecsys test could detect S-100B in 171 samples (range 0.005-0.14 microg/L). No clear relation was observed between the two methods in urine analysis (correlation coefficient 0.60). CONCLUSION: The Sangtec and Elecsys assays are not interchangeable methods when analyzing S-100B in serum or urine samples after head injury.