How informative is the print media coverage of colorectal cancer?

AIM: To date there has been no assessment of the educational content of colorectal newspaper articles. We aimed to analyse articles in the print media concerning colorectal cancer for their public health content. METHOD: Articles mentioning colorectal cancer in the top 10 UK newspapers were analysed over a 1-year period for their educational content. The number of articles mentioning 'red flag' symptoms, celebrity connections or specific cancer charities was recorded. RESULTS: Of the 349 articles identified, 146 were not relevant. Of the remaining 203 articles, 62 (30%) were concerned with celebrities with colon cancer, 13 (6.4%) made reference to red flag symptoms and 14 (6.9%) mentioned cancer charities by name. CONCLUSION: About 13% of newspaper articles have any educational content. If this increased, the general public might benefit.

Assessing the internet prevalence of cancer.

INTRODUCTION: The internet is one of the most frequently accessed sources of information by patients. There is a variety of cancer-related information provided by the internet, aimed at both the general public (from official sites and non-regulated sites) and health care professionals. Little is known about whether the information provided reflects the prevalence of disease. METHODS: Searches for the 10 most common UK cancers were performed using five internet search engines. The number of relevant webpages was recorded and compared to the prevalence of each cancer according to Cancer Research UK. RESULTS: Of the 985,687,623 webpages identified, the majority were related to breast cancer (37.2%), followed by lung (16.2%) and prostate cancer (12.5%). Colorectal cancer, Oesophageal cancer and non-Hodgkin's lymphoma had the least number of websites (4.1%, 0.3% and 0.9%, respectively). There was over-representation of breast, kidney and stomach cancer with ratios of prevalence to number of websites of 1.7, 2.6 and 2.5 to 1, respectively. There was under-representation of colorectal cancer, non-Hodgkin's lymphoma and oesophageal cancer (ratios 0.2, 0.2 and 0.1, respectively). CONCLUSION: This data highlights the enormity of information available on the internet. However, there is over-representation of certain cancers (and under-representation of others) which may influence how patients perceive their illness. Healthcare professionals should be aware of the nature of information available on the internet and known when and how to direct patients to reputable sites that provide high quality information.

Death and illness as depicted in the media.

INTRODUCTION: The media may affect how illness is perceived, in terms of its prevalence, severity and outcomes. The media also influences our perception of death and leads to an overestimation of incidence of some causes of mortality. Articles depicting medical subjects may not be in-depth and are often influenced by non-medical issues. The media has both a positive impact on the population, in providing opportunistic health information, and a negative impact, causing an overestimation of severity and incidence of certain diseases. This article aims to assess if media reporting of illness and death represents national statistics. METHOD: The 10 most common daily read UK newspapers were assessed for articles relating to the most common causes of UK mortality. The searches were performed via each newspaper's online search facility over a 12-month period. Where appropriate, media friendly terms were used as search terms. RESULTS: A total of 18,482 pertinent articles were found relating to the most common causes of death in the UK. When the reportage of illness was compared with the actual incidence cerebrovascular accidents and chronic obstructive pulmonary disease were under-represented in the media, with ratios 0.31 and 0.01 to 1, respectively. Flu/pneumonia, prostate cancer, dementia and breast cancer all have a large media profile, with ratios of 5.52, 3.06, 4.09 and 4.9 to 1, respectively. CONCLUSION: The media has a significant impact on our perceptions of illness and death. This may influence how patients seek medical attention and their concerns at consultation. Strategies to improve the educational content of the media may enhance the dissemination of health information via this resource.

Analysis of patient information leaflets provided by a district general hospital by the Flesch and Flesch-Kincaid method.

INTRODUCTION: Patient information leaflets (PILs) remain the most frequently used sources of medical information. There is a concern that the reading age of these leaflets may exceed patient comprehension, thus negating their beneficial effect. The 'Flesch Reading Ease' and the 'Flesch-Kincaid grade level' are established methods for providing reliable and reproducible scores of readability. METHOD: All available hospital PILs (171) were assessed and divided into 21 departments. Microsoft Word was used to provide Flesch and Flesch-Kincaid readability statistics and compared against the national reading age and the recommended level for provision of medical information. RESULTS: The average Flesch readability of all of the hospital's PILs is 60, with a Flesch-Kincaid grade of 7.8 (12-13 years old). There is considerable variation in the average readability between departments (Flesch readability 43.8-76.9, Flesch-Kincaid 5.4-10.2). The average scores of two departments have PILs scores suitable for patient information. CONCLUSION: Although our PILs were well laid out and easy to read, the majority would have exceeded patient comprehension. The current advice for provision of NHS information does not highlight the importance of a recommended reading level when designing a PIL. Potentially a wide group of patients are being excluded from the benefits of a PIL.

Assessing the readability statistics of national consent forms in the UK.

INTRODUCTION: When obtaining consent for an invasive procedure, the patient needs to understand what is happening to them in broad terms. Best medical practice advocates that written consent is given to acknowledge patient agreement. Across the UK, the Department of Health has provided standard consent forms for obtaining consent in all situations. Potentially these written sources of information may not be comprehended by patients and thus invalidate consent. METHOD: Consent forms were assessed by the Flesch readability and Flesch-Kincaid grade formulae and compared with the national reading age, the recommended level for patient medical information, three newspaper articles and a journal article. RESULTS: The consent forms have acceptable statistics [average Flesch readability 61.1 (range 57.2-66.1) and Flesch-Kincaid grade 7 (range 6.3-8)]. This grade, however, is above the recommended level of patient health information (Flesch-Kincaid grade 6). When the patient statements are isolated the reading statistics worsen [average Flesch readability 52.6 (range 41-62.6) and Flesch-Kincaid grade 9.6 (range 7.9-11.1)]. CONCLUSION: Consent forms should be used as adjuncts to detailed conversations, describing what a procedure involves to ensure that a patient understands, in broad terms, what is happening to them. The patient's statement section of the form may be being written at a level above patient comprehension currently and thus could invalidate any consent given. We would advocate a documented conversation with patients to ensure they have a broad understanding of the procedure and using the consent form as an adjunct to this discussion. The patient's statement section should be re-written to avoid invalidating consent.

Formation and electron-ion recombination of N4(+) following photoionization in near-atmospheric pressure N2.

The time dependent behavior of molecular nitrogen ions has been investigated following pulsed photoionization of near atmospheric pressure N(2) using multiphoton laser techniques and kinetic modeling. Multiple fluorescence bands, some unreported previously, with various temporal behaviors were observed after ultraviolet laser photoionization of N(2)(X (1)Sigma(g)). The initial N(2) ionization was generated via resonance-enhanced multiphoton ionization with focused radiation in the 275-290 nm range, where several resonant transitions are accessible. The observed optical fluorescence bands appeared to be unique to the near-atmospheric pressure N(2) condition and were shown by the evidence in this work to be the result of collisional formation and recombination of N(4)(+). Measured time dependent fluorescence spectra during and after pulsed laser photoionization of N(2), together with a coupled rate equation model, allowed for the determination of the absolute densities of N(2)(+) and N(4)(+) as these species evolved.

Popliteal venous aneurysm causing pulmonary embolism and paradoxical embolisation in a patient with antiphospholipid syndrome.

INTRODUCTION: Popliteal venous aneurysms are rare and can cause recurrent pulmonary emboli despite adequate anticoagulation. REPORT: A 43-year old patient with known antiphospholipid syndrome developed an extensive pulmonary embolus and ischaemic stroke despite anticoagulation. Duplex ultrasound confirmed a right popliteal venous aneurysm containing non-adherent multi-layered thrombus. At operation an 8 cm x 5 cm true aneurysm of the popliteal vein was excised. A postoperative echocardiogram revealed a patent foramen ovale. DISCUSSION: This case is unusual as the patient suffered a paradoxical embolism due to his patent foramen ovale. Although antiphospholipid syndrome is associated with venous thrombosis, this is usually prevented by therapeutic anticoagulation.

Operative ligation of multiple splenic artery aneurysms.

The incidence of splenic artery aneurysms (SAAs) in the background population is less than 1%. They are found with increasing frequency in the elderly, and there is a female predominance. The majority (95%) of SAAs are asymptomatic; although, symptoms include pain and a pulsating feeling in the upper abdomen. Treatment of SAAs depends on aneurysmal size and associated symptoms. Multiple SAAs are noted in 20% of patients. A 71-year-old woman with a history of both systemic and portal hypertension, hyper-splenism, and cirrhosis post chronic active hepatitis presented with a pulsating sensation and pain in her left hypochondrium. Abdominal ultrasound and CT confirmed the presence of two splenic aneurysms, which subsequently showed signs of enlargement 6 months later. At operation both aneurysms were successfully ligated and post-operative ultrasonography confirmed absence of aneurysmal flow and viability of the spleen.

Metachronous small bowel metastasis from a mixed Müllerian mesodermal tumour.

A mixed Müllerian mesodermal tumour (MMMT) is a rare aggressive carcinosarcoma. Metastatic progression is uncommon, and occurs via haematological, lymphatic and intraperitoneal spread. Although the latter is seen most frequently, the small intestine seems to be relatively preserved from disease progression with only one reported case of synchronous involvement. We report a case of metachronous MMMT involvement of the small bowel presenting with subacute obstruction that was successfully resected at operation.

Expression and characterization of protein geranylgeranyltransferase type I from the pathogenic yeast Candida albicans and identification of yeast selective enzyme inhibitors.

Protein geranylgeranyltransferase type I (GGTase I) is a heterodimeric zinc metalloenzyme catalyzing protein geranylgeranylation at cysteine residues present in C-terminal signature sequences referred to as CaaX (X=Leu) motifs. We have studied GGTase I as a potential antifungal target and recently reported its purification and cloning from the yeast Candida albicans (Ca GGTase I), an important human pathogen. Here, we report the high yield bacterial expression of Ca GGTase I by coexpression of maltose binding protein fusion proteins of both the alpha (Ram2p) and beta (Cdc43p) subunits. The cleaved and purified recombinant Ca GGTase I was demonstrated to be functional and structurally intact as judged by the presence of one equivalent of a tightly bound zinc atom and the near stoichiometric formation, isolation and catalytic turnover of a geranylgeranyl pyrophosphate-GGTase I complex. Kinetic analysis was performed with a native substrate protein, Candida Cdc42p, which exhibited significant pH dependent substrate inhibition, a feature not observed with other Ca GGTase I substrates. Prenyl acceptor substrate specificity was studied with a series of peptides in which both the CaaX motif, and the sequence preceding it, were varied. The prenyl acceptor K(M)s were found to vary nearly 100-fold, with biotinyl-TRERKKKKKCVIL, modeled after a presumably geranylgeranylated Candida protein, Crl1p (Rho4p), being the optimal substrate. A screen for inhibitors of Ca GGTase I identified compounds showing selectivity for the Candida versus human GGTase I. The most potent and selective compound, L-689230, had an IC(50) of 20 nM and >12,500-fold selectivity for Ca GGTase I. The lack of significant anti-Candida activity for any of these inhibitors is consistent with the recent finding that GGTase I is not required for C. albicans viability [R. Kelly et al., J. Bacteriol. 182 (2000) 704-713].

Inhibitors of dihydrodipicolinate reductase, a key enzyme of the diaminopimelate pathway of Mycobacterium tuberculosis.

Tuberculosis (TB) remains a leading cause of infectious disease in the world today and therapies developed over the last forty years are becoming increasingly ineffective against resistant strains of Mycobacterium tuberculosis. In an effort to explore new mechanisms for drug development, we have investigated the enzymes of the diaminopimelate biosynthetic pathway as potential targets. Specifically, dihydrodipicolinate reductase, the essential gene product of dapB, was screened for novel inhibitors. Inhibitors were identified both by a molecular modeling approach which utilized the available crystal structure of the enzyme with an inhibitor bound at the active site as well as by more conventional screening strategies. The resulting compounds contain a number of structural motifs and were all found to be competitive with respect to the DHDP substrate. The K(i) values for the inhibitors range from 10 to 90 microM. The molecular modeling approach was very effective in identifying novel inhibitors of the enzyme. These compounds were obtained at a higher frequency based on the number of compounds analyzed than those inhibitors discovered via conventional screening. However, conventional screening proved beneficial in identifying compounds with greater structural diversity.

Modeling kappa for measuring dependent categorical agreement data.

A method for analysing dependent agreement data with categorical responses is proposed. A generalized estimating equation approach is developed with two sets of equations. The first set models the marginal distribution of categorical ratings, and the second set models the pairwise association of ratings with the kappa coefficient (kappa) as a metric. Covariates can be incorporated into both sets of equations. This approach is compared with a latent variable model that assumes an underlying multivariate normal distribution in which the intraclass correlation coefficient is used as a measure of association. Examples are from a cervical ectopy study and the National Heart, Lung, and Blood Institute Veteran Twin Study.

A process for the separation of 177Lu from neutron irradiated 176Yb targets.

A conceptual flowsheet has been developed for the separation of (177)Lu from a 300 mg neutron irradiated (176)Yb enriched target. The key component of the process is an extraction chromatographic (EXC) resin containing 2-ethylhexyl 2-ethylhexylphosphonic acid (HEH[EHP]) sorbed onto a 25-53 microm Amberchrom CG-71 substrate. The process is divided into three sections: (1) front-end target removal system, (2) primary separation system and (3) secondary separation system. Each section involves the separation of Yb and Lu using the HEH[EHP] resin followed by concentration and acid adjustment of the Lu-rich eluate using an EXC material containing a diglycolamide extractant. The use of the diglycolamide EXC material is a significant feature of the flowsheet, allowing one to avoid lengthy evaporations and acidity adjustments between successive HEH[EHP] column runs while removing adventitious impurities from the (177)Lu. The overall recovery of (177)Lu is estimated at 73% with an overall decontamination factor from Yb of 10(6). The overall processing time can be as short as 4h.

Delayed laparoscopic mesh infection presenting as an abdominal mass.

A 56-year-old man presented with a delayed mesh infection 8 years following an elective laparoscopic totally extraperitoneal (TEP) bilateral hernia repair. Sterile pus was drained percutaneously as a temporising measure prior to removal of the right-hand mesh; the left-sided mesh was adherent to the femoral vessels and minimally contaminated. Delayed mesh infection is a rare occurrence. This case is the fourth example and the longest following initial operation. Removal of the infected mesh is advocated.

A structurally unique, potent, and selective oxytocin antagonist derived from Streptomyces silvensis.

The in vitro and in vivo oxytocin/arginine vasopressin (OT/AVP) antagonist properties of two cyclic hexapeptides derived from a newly discovered natural product (L-156,373) of Streptomyces silvensis are described. In radioligand binding assays, L-156,373 [cyclo(L-Pro-D-Phe-N-OH-L-Ile-D-piperazyl-L-piperazyl-N-Me-D -Phe)] exhibited moderate affinity for rat uterine OT receptors (Ki, 150 nM), with some selectivity (approximately 20-fold) vs. liver AVP-V1 and kidney AVP-V2 receptors. Dehydroxylation of N-hydroxyisoleucine and oxidation of the piperazic acid residues of L-156-373 produced an interesting derivative, L-365,209. These structural modifications increased OT receptor affinity and selectivity by 20- and 2.5-5-fold, respectively. In the isolated rat uterus, L-365,209 was a potent (apparent dissociation constant, 1.7 nM) and competitive OT antagonist. L-365,209 also blocked the effects of AVP at both AVP-V1 (phosphatidylinositol turnover in rat hepatocytes) and AVP-V2 (adenylate cyclase in rat kidney medulla) receptors, but only at low micromolar concentrations. L-365,209, given iv to anesthetized rats, antagonized the action of exogenous OT on the uterus (ID50, 460 micrograms/kg) with a relatively long duration of action. L-365,209 represents a unique class of compounds that provides an entirely new approach for the design of antagonists for these neurohypophyseal hormones.

Aberrant neuronal physiology in the basal nucleus of the amygdala in a model of chronic limbic epilepsy.

Limbic epilepsy is a chronic condition associated with a broad zone of seizure onset and pathology. Studies have focused mainly on the hippocampus, but there are indications that changes occur in other regions of the limbic system. This study used in vitro intracellular recording and histology to examine alterations to the physiology and anatomy of the basal nucleus of the amygdala in a rat model of chronic limbic epilepsy characterized by spontaneously recurring seizures. Epileptic pyramidal neuron responses evoked by stria terminalis stimulation revealed hyperexcitability characterized by multiple action potential bursts and no evident inhibitory potentials. In contrast, no hyperexcitability was observed in amygdalar neurons from kindled (included as a control for seizure activity) or control rats. Blockade of ionotropic glutamate receptors unmasked inhibitory postsynaptic potentials in epileptic pyramidal neurons. Control, kindled and epileptic inhibitory potentials were predominantly biphasic, with fast and slow components, but a few cells exhibited only the fast component (2/12 in controls, 0/3 in kindled, 3/10 in epileptic). Epileptic fast inhibitory potentials had a more rapid onset and shorter duration than control and kindled. Approximately 40% of control neurons exhibited spontaneous inhibitory potentials; no spontaneous inhibitory potentials were observed in neurons from kindled or epileptic rats. A preliminary histological examination revealed no gross alterations in the basal amygdala from epileptic animals. These results extend previous findings from this laboratory that hyperexcitability is found in multiple epileptic limbic regions and may be secondary to multiple alterations in excitatory and inhibitory efficacy. Because there were no differences between control and kindled animals, the changes observed in the epileptic animals are unlikely to be secondary to recurrent seizures.

Somatostatin, neuropeptide Y, neurokinin B and cholecystokinin immunoreactivity in two chronic models of temporal lobe epilepsy.

Somatostatin-, neuropeptide Y-, neurokinin B- and cholecystokinin-containing neurons were investigated in the rat hippocampus in two chronic models of temporal lobe epilepsy, i.e. 30 days after rapid kindling or electrically induced status epilepticus (post-status epilepticus). After rapid kindling, somatostatin immunoreactivity was strongly increased in interneurons and in the outer and middle molecular layer of the dentate gyrus. In four of six post-status epilepticus rats (status epilepticus I rats), somatostatin immunoreactivity was slightly increased in the dorsal but decreased in the ventral dentate gyrus and molecular layer. Somatostatin immunoreactivity decreased in neurons of the dorsal hilus in the two other post-status epilepticus rats investigated, while a complete loss was found in the respective ventral extension (status epilepticus-II rats). These changes were associated with a different extent of neurodegeneration as assessed by Nissl staining. Similarly, neuropeptide Y immunoreactivity was enhanced in neurons of the hilus and in the middle and outer molecular layer of the dentate gyrus in the dorsal hippocampus of rapidly kindled and status epilepticus-I rats. Neuropeptide Y and neurokinin B immunoreactivity was enhanced in the mossy fibers of all post-status epilepticus rats, but not in the rapidly kindled rats. In status epilepticus-II rats, neuropeptide Y-and neurokinin B-positive fibers were also detected in the infrapyramidal region of the stratum oriens of CA3 and in the inner molecular layer of the dentate gyrus in the dorsal and ventral hippocampus respectively, labeling presumably sprouted mossy fibers. Increased staining of neuropeptide Y and neurokinin B was found in the alveus after rapid kindling. Cholecystokinin immunoreactivity was markedly increased in the cerebral cortex, Ammon's horn and the molecular layer of the dentate gyrus in the ventral hippocampus of rapidly kindled and post-status epilepticus rats. The lasting changes in the immunoreactive pattern of various peptides in the hippocampus may reflect functional modifications in the corresponding peptide-containing neurons. These changes may be involved in chronic epileptogenesis, which evolves in response to limbic seizures.

Adverse reactions to sulphasalazine and 5-amino salicylic acid in the same patient.

We report a patient who developed sulphasalazine-related hepatitis with a subsequent adverse reaction to rectal 5-amino salicylic acid, in the form of pain and fever without associated liver dysfunction, suggesting reactions to both components of sulphasalazine. Included is a review of the literature. Caution should be observed when prescribing 5-amino salicylic acid to sulphasalazine-intolerant patients.

Frozen section simulation of trabecular adenoma and medullary cancer by papillary thyroid carcinoma.

Two patients are reported in whom initial misdiagnoses of medullary cancer or trabecular hyaline adenoma for papillary carcinoma were made.

Red cell survival in biliary cirrhosis.

Studies were carried out on eight patients with primary biliary cirrhosis. Four patients were found to have a haemolytic anaemia; one had Coombs red cell antibodies. Two patients had evidence of splenic sequestration of red cells using the radio-chromium technique. There was a significant correlation between the red cell survival and the bromsulphthalein retention test and the red cell survival and the serum level of bilirubin. It was concluded that the anaemia of cirrhosis of the liver, including primary biliary cirrhosis, may be due to a number of mechanisms and a unifying hypothesis based on the degree of liver dysfunction is suggested.