Colorectal cancer patients' preferences for type of caregiver during survivorship care.

PURPOSE: Colorectal cancer (CRC) survivors are currently included in a secondary care-led survivorship care programme. Efforts are underway to transfer this survivorship care to primary care, but met with some reluctance by patients and caregivers. This study assesses (1) what caregiver patients prefer to contact for symptoms during survivorship care, (2) what patient factors are associated with a preferred caregiver, and (3) whether the type of symptom is associated with a preferred caregiver. METHODS: A cross-sectional study of CRC survivors at different time points. For 14 different symptoms, patients reported if they would consult a caregiver, and who they would contact if so. Patient and disease characteristics were retrieved from hospital and general practice records. RESULTS: Two hundred and sixty patients participated (response rate 54%) of whom the average age was 67, 54% were male. The median time after surgery was seven months (range 0-60 months). Patients were divided fairly evenly between tumour stages 1-3, 33% had received chemotherapy. Men, patients older than 65 years, and patients with chronic comorbid conditions preferred to consult their general practitioner (GP). Women, patients with stage 3 disease, and patients that had received chemotherapy preferred to consult their secondary care provider. For all symptoms, patients were more likely to consult their GP, except for (1) rectal blood loss, (2) weight loss, and (3) fear that cancer had recurred, in which case they would consult both their primary and secondary care providers. Patients appreciated all caregivers involved in survivorship care highly; with 8 out of 10 points. CONCLUSIONS: CRC survivors frequently consult their GP in the current situation, and for symptoms that could alarm them to a possible recurrent disease consult both their GP and secondary care provider. Patient and tumour characteristics influence patients' preferred caregiver.

A comparison of short-term outcome after laparoscopic, transverse, and midline right-sided colectomy.

AIM: The aim of the present study was to compare the laparoscopy, transverse, and midline laparotomy in right-sided colectomies with respect to short- and long-term outcome. METHODS: The short- and long-term results of all patients who had an elective right-sided hemicolectomy, from January 2006 to April 2009 for malignant or benign disease, were evaluated according to the surgical technique: laparoscopic, midline, or transverse incision laparotomy. RESULTS: The 75 included patients (41% male) had laparoscopy (n = 30), midline (n = 22), or transverse incision laparotomy (n = 23). Median operating time in the laparoscopy group was significantly longer in comparison to the midline and transverse incision groups (129, 105, and 101 min respectively, p < 0.001). Short-term follow-up revealed a longer median total length of stay in the midline laparotomy group compared to the other groups (9 vs. 7 days, p = 0.026). Thirty-day morbidity was less in the laparoscopy and transverse incision groups compared to the midline laparotomy group (15%, 20%, and 41%; p = 0.06). After excluding patients who had a previous midline incision, an earlier return of bowel function was seen for laparoscopy and transverse hemicolectomy (3 vs. 5 days, p = 0.017). At a median follow-up of 40 months (21-58), four incisional hernias occurred, two in the midline laparotomy group (one operatively corrected) and two in the laparoscopy group. CONCLUSIONS: Although the results of this study need to be interpreted with care, our study shows that laparoscopic and transverse right hemicolectomy are equivalent and have a significant better short-term outcome compared to an open midline approach. In particular, laparoscopy and transverse laparotomy result in >50% reduction in 30-day morbidity, no reoperations, and a shorter median total hospital stay of 2 days.

Which fast track elements predict early recovery after colon cancer surgery?

AIM: It is questioned whether all separate fast track elements are essential for enhanced postoperative recovery. We aimed to determine which baseline characteristics and which fast track elements are independent predictors of faster postoperative recovery in patients undergoing resection for colon cancer. METHOD: Data from the LAFA trial database were used. In this trial, fast track care was compared with standard perioperative care in 400 patients undergoing laparoscopic or open surgery for colonic cancer. During admission 19 fast track elements per patient were prospectively evaluated and scored whether or not they were successfully applied. To identify predictive factors six baseline characteristics and those fast track items that were successfully achieved were entered in a univariate and multivariate linear regression analysis with total postoperative hospital stay (THS) as the primary outcome. RESULTS: In 400 patients, two baseline characteristics and two fast track elements were found to be significant independent predictors of THS: female sex [B = 0.85; 95% CI 0.75-0.96; reduction of 15% (CI 14-25%) in THS], laparoscopic resection [B = 0.85; 95% CI 0.75-0.96; reduction of 15% (CI 14-25%) in THS], 'normal diet at postoperative days 1, 2 and 3' [B = 0.70; 95% CI 0.61-0.81; reduction of 30% (CI 19-39%) in THS] and 'enforced mobilization at postoperative days 1, 2 and 3' [B = 0.68; 95% CI 0.59-0.80; reduction of 32% (CI 20-41%) in THS]. CONCLUSION: Evaluating only those fast track elements that were successfully achieved, enforced advancement of oral intake, early mobilization, laparoscopic surgery and female sex were independent determinants of early recovery.

Preservation of kidneys from controlled donors after cardiac death.

BACKGROUND: Donation after cardiac death (DCD) expands the pool of donor kidneys, but is associated with warm ischaemic injury. Two methods are used to preserve kidneys from controlled DCD donors and reduce warm ischaemic injury: in situ preservation using a double-balloon triple-lumen catheter (DBTL) inserted via the femoral artery and direct cannulation of the aorta after rapid laparotomy. The aim of this study was to compare these two techniques. METHODS: This was a retrospective cohort study of 165 controlled DCD procedures in two regions in the Netherlands between 2000 and 2006. RESULTS: There were 102 donors in the DBTL group and 63 in the aortic group. In the aortic group the kidney discard rate was lower (4·8 versus 28·2 per cent; P < 0·001), and the warm (22 versus 27 min; P < 0·001) and the cold (19 versus 24 h; P < 0·001) ischaemia times were shorter than in the DBTL group. Risk factors for discard included preservation with the DBTL catheter (odds ratio (OR) 5·19, 95 per cent confidence interval 1·88 to 14·36; P = 0·001) and increasing donor age (1·05, 1·02 to 1·07; P < 0·001). Warm ischaemia time had a significant effect on graft failure (hazard ratio 1·04, 1·01 to 1·07; P = 0·009), and consequently graft survival was higher in the aortic cannulation group (86·2 per cent versus 76·8 per cent in the DBTL group at 1 year; P = 0·027). CONCLUSION: In this retrospective study, direct aortic cannulation appeared to be a better method to preserve controlled DCD kidneys.

Registering the critical view of safety: photo or video?

BACKGROUND: One of the most important ways to reduce biliary duct injury in laparoscopic cholecystectomy is to achieve the critical view of safety (CVS) before transection of the cystic artery and duct. Documenting CVS is possible with photo prints, video imaging, or both. These documentations can be used as a proof of the right procedure in case of biliary duct injury, but only if the documentation is good enough to be judged independently by others. METHODS: In 102 consecutive laparoscopic cholecystectomies, CVS was recorded by photo prints and video images. Imaging was done just before transection of the cystic artery and duct. The photo prints and video images were analyzed independently by two surgeons. These surgeons had to judge whether the documentation method was of sufficient quality to determine whether CVS was achieved. RESULTS: Photo prints were made for 81% and video images for 59% of the 102 patients treated with a laparoscopic cholecystectomy. The mean age of the patients was 54 years (range, 22-83 years), and 71% were women. The diagnosis for 62 of the patients was symptomatic cholecystolithiasis, and 18 patients had acute cholecystitis. The remaining patients had earlier experienced acute cholecystitis, biliary pancreatitis, or endoscopic retrograde cholangiopancreatography (ERCP). Respectively, 30% and 21% of the CVS photo prints were judged to be of insufficient quality to determine whether CVS had been established, mostly because of difficulties adequately showing the lateral side (κ = 0.67). In all but two video images, achievement of CVS was documented sufficiently to be judged 97% (κ = 1.00). CONCLUSION: Photo prints are inferior to video images for judging achievement of CVS. Therefore, a practical and logistical solution must be devised in hospitals for storage and insight in all video documentation, for example, by implementation of a link with the electronic patient database.

Neurosarcoidosis presenting as an isolated intrasellar mass: case report and review of the literature.

OBJECTIVE: Isolated neurosarcoidosis without evidence of extracranial manifestation continues to be a rare phenomenon. This case report and others in the literature demonstrate the difficulty in making the diagnosis of isolated neurosarcoidosis, as it may be indistinguishable from other pathologies on radiographic and laboratory studies. This case report and review of the literature will emphasize the need for clinical suspicion for neurosarcoidosis in patients with intrasellar lesions and the appropriate clinical history. CASE HISTORY: A 37-year-old female presented with visual field changes and a headache unresponsive to nonsteroidal anti-inflammatory medications. A history of Bell's palsy, hypothyroidism, and a history of sarcoidosis in the patient's father were noted. Imaging revealed an intrasellar mass resembling a pituitary macroadenoma. Routine neuroendocrine laboratory studies were consistent with hypopituitarism, and all other standard laboratory tests were normal. An endonasal transsphenoidal resection of the intrasellar lesion was done. The tissue was inconsistent with a typical adenoma. Intraoperative pathology reported non-caseating granulomatous disease. Based on the patient's history and intraoperative pathology she was diagnosed with neurosarcoidosis, which was confirmed by final pathologic analysis. Minimal debulking was performed to decompress the optic chiasm. The patient was then placed on corticosteroids and methotrexate and responded well to medical therapy. CONCLUSION: If isolated neurosarcoidosis is diagnosed early it will save a costly and invasive work-up. Radiographic and laboratory studies may aid in diagnosis but no studies are pathognomonic. Neurosarcoidosis is diagnosed by a combination of imaging, diagnostic tests, and good clinical suspicion.

Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme.

BACKGROUND: Fast track surgery accelerates recovery, reduces morbidity and shortens hospital stay. It is unclear what the effects are of laparoscopic or open surgery within a fast track programme. The aim of this systematic review was to review the existing evidence. METHOD: A systematic review was performed of all randomized (RCTs) and controlled clinical trials (CCTs) on laparoscopic and open surgery within a fast track setting. Primary endpoints were primary and overall hospital stay, readmission rate, morbidity and mortality. Study selection, quality assessment and data extraction were performed independently by two observers. RESULTS: Only two RCTs and three CCTs were eligible for final analysis, which reported on 400 patients. Data could not be pooled because of clinical heterogeneity. One RCT and one CCT stated a shorter primary hospital stay in the laparoscopic group of 3 and 2 days, respectively. In one RCT, the readmission rate was lower in the laparoscopic group; absolute risk reduction (ARR) 21.4% [95% confidence interval (CI): 6-42.3%] resulting in a number needed to treat (NNT) of 4.7 patients (95% CI: 2.4-176). Another study showed a 23% difference in favour of the laparoscopic group with regard to morbidity (95% CI: 6.3-39.1%), i.e. an NNT of 4.4 patients (95% CI: 2.6-15.9). There were no significant differences in mortality rates. CONCLUSION: Due to the present lack of data, no robust conclusions can be made. A large randomized controlled trial is required to compare laparoscopic with open surgery within a fast track setting.

Extensive injury after use of a mechanical cardiopulmonary resuscitation device.

We report a case of a 49-year-old woman with a ruptured liver and spleen found at autopsy, which may have been related to the use of a mechanical cardiopulmonary resuscitation (CPR) device (AutoPulse, ZOLL Medical Corporation, Chelmsford, Mass). She was admitted because of an out-of-hospital resuscitation, and under the suspicion of a pulmonary embolism, a thrombolytic agent was administered. Despite prolonged continuation of mechanical CPR, she died of persistent asystole. The evidence for improved outcomes after the use of a mechanical CPR device during resuscitation is still scarce. To prevent the unique complications reported here, regular checking of proper position of the chest band during resuscitation is advised.

Information needs and information seeking behaviour of patients during follow-up of colorectal cancer in the Netherlands.

PURPOSE: Adequately informing patients is considered crucial in cancer care, but need for information and information seeking behaviour of colorectal cancer (CRC) patients in the Netherlands are currently not well known. METHODS: In a prospective study, patients participating in a specialty, hospital-based follow-up program completed three consecutive surveys over a 6-month period to analyse their information need and information seeking behaviour. RESULTS: Patients (n = 259) felt well informed about their treatment (86%), disease (84%), and follow-up program (80%), but less well informed about future expectations (49%), nutrition (43%), recommended physical activity (42%), and heredity of cancer (40%). The need for more information on these subjects remained constant over the first five postoperative years. Patients who were younger, who had undergone chemotherapy, or who had comorbid conditions needed more information on several subjects. One in three patients searched for information themselves, mostly on the Internet. One in four patients consulted a health care provider for information, mostly their GP. Younger and more educated patients more often searched for information themselves, while patients undergoing chemotherapy more often consulted the hospital nurse. Information seeking behaviour remained constant over time. CONCLUSIONS: This study showed where current information provision is perceived as adequate and on which subject improvements can be made. It identifies information seeking behaviour and proposes ways to personalize information provision. IMPLICATIONS FOR CANCER SURVIVORS: The GP is most frequently consulted for information; involving GPs in CRC follow-up could improve information provision on several subjects for several patients.

Staple line failure using the Proximate 100 mm linear cutter.

PURPOSE: An incomplete linear staple line that was discovered during the stapling of an ileal pouch alerted us to evaluate potential usage concerns with linear cutters. This study was designed to assess the integrity of the staple line of three different sizes of linear staplers. METHODS: In an animal model three different lengths of linear cutters (Proximate, Ethicon Endo-Surgery) were used to cross-staple and transect the large bowel of one pig to check for the integrity of the proximal end of the staple line. RESULTS: Cross-stapling and transecting across the pig's large bowel demonstrated that if the tissue is advanced up to the highest number on the scale of the 100 mm stapling device, insufficient overlap between the proximal end of the staple line and the proximal end of the cut line occur. CONCLUSIONS: Although a more than 100 mm staple line is delivered, the 100 mm cutter may not produce a double-staggered row of staples at the most proximal end of the staple line if the tissue is advanced past the 9.5 cm mark. Ethicon Endo-Surgery has agreed to add indicator markers to the scale label on the instrument to provide the user with additional guidance for tissue placement.

Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery.

BACKGROUND: Anastomotic leakage is associated with high morbidity and mortality rates. The aim of this study was to assess the potential benefits of a laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery. METHODS: Between January 2003 and January 2006, ten patients who had laparoscopic colorectal resection and later developed anastomotic leakage had a laparoscopic reintervention. A second group included 15 patients who had relaparotomy after primary open surgery. RESULTS: Patient characteristics were comparable in the two groups. The median time from first operation to reintervention was 6 days in both groups. There were no conversions. The intensive care stay was shorter in the laparoscopic group (1 versus 3 days; P = 0.002). Resumption of a normal diet (median 3 versus 6 days; P = 0.031) and first stoma output (2 versus 3 days; P = 0.041) occurred earlier in the laparoscopic group. The postoperative 30-day morbidity rate was lower (four of ten patients versus 12 of 15; P = 0.087) and hospital stay was shorter (median 9 versus 13 days; P = 0.058) in the laparoscopic group. No patient developed incisional hernia in the laparoscopic group compared with five of 15 in the open group (P = 0.061). CONCLUSION: These data suggest that laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery is associated with less morbidity, faster recovery and fewer abdominal wall complications than relaparotomy.

A systematic review on the significance of extracapsular lymph node involvement in gastrointestinal malignancies.

AIMS: The impact of extracapsular lymph node involvement (LNI) has been studied for several malignancies, including gastrointestinal malignancies. Aim of this study was to assess the current evidence on extracapsular LNI as a prognostic factor for recurrence in gastrointestinal malignancies. METHODS: The Cochrane Database of systematic reviews, the Cochrane central register of controlled trials, and MEDLINE databases were searched using a combination of keywords relating to extracapsular LNI in gastrointestinal malignancies. Primary outcome parameters were incidence of extracapsular LNI and overall five-year survival rates. FINDINGS: Fourteen manuscripts were included, concerning seven oesophageal, three gastric, one colorectal, and three rectal cancer series with a total of 1528 node positive patients. The pooled incidence of extracapsular LNI was 57% (95% CI: 53-61%) for oesophageal cancer, 41% (95% CI: 36-47%) for gastric cancer, and 35% (95% CI: 31-40%) for rectal cancer. In nine of the 14 studies a multivariate analysis was performed. In eight of these nine studies extracapsular LNI was identified as an independent risk factor for recurrence. CONCLUSION: Extracapsular LNI is a common phenomenon in patients with gastrointestinal malignancies. It identifies a subgroup of patients with a significantly worse long-term survival. This systematic review highlights the importance of assessing extracapsular LNI as a valuable prognostic factor. Pathologists and clinicians should be aware of this important feature.

Follow-up of colon cancer patients; causes of distress and need for supportive care: Results from the ICARE Cohort Study.

BACKGROUND: Colon cancer survivors experience physical and psychosocial problems that are currently not adequately addressed. This study investigated distress in patients after curative surgery for colon cancer and studied how this corresponds with the need for supportive care. METHODS: Prospective cohort of patients with stage I-III colon carcinoma, treated with curative intent, currently in follow-up at 6 different hospitals. A survey recorded symptoms, experienced problems, and (un)expressed needs. Satisfaction with supportive care was recorded. RESULTS: Two hundred eighty four patients were included; 155 males and 129 females, with a mean age of 68 years (range 33-95), and a median follow-up of 7 months. 227 patients completed the survey. Patients experienced a median of 23 symptoms in the week before the survey, consisting of a median of 10 physical, 8 psychological and 4 social symptoms. About a third of these symptoms was felt to be a problem. Patients with physical problems seek supportive care in one in three cases, while patients with psychosocial problems only seek help in one in eight cases. Patients who recently finished treatment, finished adjuvant chemotherapy, or had a stoma, had more symptoms and needed more help in all domains. Patients most frequently consulted general practitioners (GPs) and surgeons, and were satisfied with the help they received. CONCLUSION: Colon cancer survivors experience many symptoms, but significantly fewer patients seek help for a psychosocial problem than for a physical problem. Consultations with supportive care are mainly with GPs or surgeons, and both healthcare providers are assessed as providing satisfying care.

[Elective colon surgery according to a 'fast-track' programme]. / Electieve colonoperaties volgens een 'sneltraject'-programma.

In fast-track surgical programmes, a variety ofperioperative elements are combined in an intensive multidisciplinary approach for the purpose of preserving the preoperative body composition and organ functions and actively stimulating functional recovery. Such programmes have already been introduced in several surgical procedures. The essence of fast-track colon surgery consists of extensive preoperative counselling, adequate preoperative nutrition with the avoidance of prolonged fasting, a minimum of invasive procedures and anaesthesia, no routine use of drains and nasogastric tubes, adequate perioperative analgesia encompassing high thoracic epidural anaesthesia, rapid mobilisation, rapid resumption of postoperative feeding, and medicinal support with prokinetics and laxatives. A systematic review shows that this programme accelerates recovery and hence shortens the primary and total hospital stay.

Synthesis and structure-activity relationships of new 9-N-alkyl derivatives of 9(S)-erythromycylamine.

A series of new 9-N-alkyl derivatives of 9(S)-erythromycylamine has been synthesized by reductive alkylation of erythromycylamine with aliphatic aldehydes and sodium cyanoborohydride. Alternative syntheses employing hydrogenation methods have also been developed. These new 9-N-alkyl derivatives possess excellent antimicrobial activity in vitro and in vivo, especially when administered orally to treat experimental infections in mice. From structure-activity studies, 9-N-(1-propyl)erythromycylamine (LY281389) was selected as the most efficacious derivative. These methods have also been extended to the synthesis of some 9-N,N-dialkyl derivatives of erythromycylamine.

Stimulation of calcitonin/CGRP-I and CGRP-II gene expression by dibutyryl cAMP in a human medullary thyroid carcinoma (TT) cell line.

In a human medullary thyroid carcinoma (TT) cell line, expression of the calcitonin (CT)/CT gene-related peptide (CGRP-I) gene (CALC-I or alpha) at the level of mRNA and of encoded peptides is higher than that of the closely related CGRP-II gene (CALC-II or beta). In response to 1 mM dibutyryl cAMP ((Bu)2cAMP), mature CGRP-II mRNA and intact cellular CGRP-II were raised 65- and 10-fold, respectively, at 72 h. Also at 72 h, 1 mM sodium butyrate enhanced CGRP-II mRNA only 9-fold and cellular CGRP-II 2-fold; stimulation of CGRP-I and CT mRNA and of cellular CGRP-I and CT by both (Bu)2cAMP and sodium butyrate was similarly low. During the same incubation time period secreted CGRP-II was raised 44-fold in response to (Bu)2cAMP, and CGRP-I and CT 8- and 42-fold, respectively. In conclusion, gene products of CALC-I (CGRP-I and CT) are present in higher amounts in TT cells than those of CALC-II (CGRP II). Yet (Bu)2cAMP predominantly stimulates the expression of CALC-II.

Synthesis, antimicrobial evaluation and structure-activity relationships within 23-modified derivatives of 5-O-mycaminosyltylonolide.

A large series of C-23-modified derivatives of 5-O-mycaminosyltylonolide were synthesized, in which the C-23 hydroxyl group was replaced by halo, aryl ether or thioether, azido, amino or dialkylamino substituents via SN2 displacement reactions. The majority of derivatives possessed excellent in vitro activity against a variety of aerobic and anaerobic bacteria. While some of the compounds treated experimental infections in rodents by parenteral administration, none showed any significant efficacy or bioavailability after oral dosing. Novel rearrangement products were obtained from some of the reactions; these were identified as 13,23-cyclopropyl-12,22-exomethylene and 13,23-cyclopropyl-12-alkoxy derivatives.

Synthesis and antimicrobial evaluation of 20-deoxo-20-(3,5-dimethylpiperidin-1-yl)desmycosin (tilmicosin, EL-870) and related cyclic amino derivatives.

A series of 20-deoxo-20-cyclic (alkylamino) derivatives of tylosin, desmycosin, macrocin and lactenocin was prepared by reductive amination of the C-20 aldehyde group. The majority of the compounds were prepared using metal hydrides (sodium cyanoborohydride or sodium borohydride) as the reducing agents and a suitable cyclic alkylamine. Subsequently, a more convenient procedure was developed using formic acid as a reducing agent. The C-20 amino derivatives prepared from desmycosin exhibited good in vitro antimicrobial activity against Pasteurella haemolytica and Pasteurella multocida (MIC range of 0.78 approximately 6.25 micrograms/ml) as well as Mycoplasma species (MIC range of 0.39 approximately 6.25 micrograms/ml). Several derivatives showed excellent oral efficacy against infections caused by P. multocida in chicks. One of these derivatives, 20-deoxo-20-(3,5-dimethylpiperidin-1-yl)desmycosin (tilmicosin or EL-870) was selected for development as a therapeutic agent for pasteurellosis in calves and pigs.

An eye-ear syndrome? A hypothesis.

A ring-like pigment deposit in the perilimbic conjunctiva of dark-skinned subjects was found more frequently among deaf than among non-deaf children in Tanzania and Kenya, and in both more frequently in these countries than in South Africa, Florida, Malawi, India and Ethiopia. It is hypothesized that this is due to differences in the regions' general health conditions, in the individual's case history, in genetically determined pigmentation, and in the individual's age.

[Acute respiratory distress syndrome more frequently diagnosed in intensive care patients in the Netherlands than would occur according to internationally established criteria]. / 'Acute respiratory distress'-syndroom bij intensivecarepatiënten in Nederland vaker gediagnosticeerd dan zou gebeuren op basis van internationaal vastgestelde criteria.

OBJECTIVE: To determine the agreement of the diagnosis 'acute respiratory distress syndrome' (ARDS) established by intensive care (IC) specialists, with that according to internationally accepted objective criteria. DESIGN: Descriptive inventory. METHOD: All 119 hospitals in the Netherlands with an IC department were asked to participate; 34 did (29%). On 3 consecutive days, IC specialists completed a case-record form concerning the respiratory status and additional treatment of all of their patients. In the case of mechanical ventilation, the specialist could indicate whether ARDS or another condition was the cause of the respiratory insufficiency. In addition to this, objective data were requested so that the investigators could establish whether there was ARDS on the basis of the North American-European Consensus Conference (NAECC) criteria and the less generally accepted 'Lung injury score' (LIS > or = 2.5). RESULTS: Of the 266 patients about whom a case record form was returned, 151 were mechanically ventilated. ARDS was diagnosed in 36 of these patients according to the IC specialists, in 24 according to the NAECC and in 20 according to the LIS criteria (p < 0.05 versus IC specialists). The chance-corrected agreement (kappa) between the diagnoses by IC specialists and the NAECC criteria was 0.34 (p < 0.001) and between the IC specialists and the LIS 0.44 (p < 0.001). The kappa between the NAECC and the LIS diagnoses was 0.42 (p < 0.001). Using NAECC and/or LIS criteria as the golden standard, a correct ARDS diagnosis was made by the IC specialists in the case of 20 patients, a false-positive diagnosis in the case of 16 patients and a false-negative diagnosis in the case of 13 patients. CONCLUSION: In this investigation, the diagnosis of ARDS was more frequently established than would occur according to the NAECC criteria.