Clinical characteristics of people with intellectual disability admitted to hospital with constipation: identifying possible specific high-risk factors.

BACKGROUND: People with intellectual disabilities (ID) die on an average 20 years earlier to the general population. They have higher rates of multimorbidity and polypharmacy. Around 25% of people with ID report chronic constipation. The England Learning Disabilities Mortality Review found that nearly 25% of deaths identified constipation as a long-term health problem. However, the likely risk factors for constipation related harm are poorly enumerated. We sought to identify possible specific high-risk factors by examining the clinical characteristics of people with ID admitted to hospital with constipation. METHODS: Data of people with ID admitted with constipation in two general hospitals covering a population of 1.3 million from 2017 to 2022 were reported using the STROBE guideline for cohort studies. Collected data included age, gender, intellectual disability severity, recorded medication, presenting complaint and co-morbidities. The medication anticholinergic burden was calculated using the anticholinergic burden scale. Continuous variables were summarised by mean and standard deviation if normally distributed, with categorical variables summarised by the number and percentage in each category. RESULTS: Of 46 admissions (males 52%), 57% had moderate to profound ID, 37% had epilepsy, 41% prescribed antiseizure medication (ASM) and 45% were on laxatives. Average age was 46 years. The anticholinergic burden score mean was 2.3 and median, one. CONCLUSIONS: We can hypothesise that people with more severe ID, suffering from epilepsy and on ASM may be more at risk of developing severe constipation. Some admissions may be avoided with earlier use of laxatives in the community.

Long-term outcomes of clinical and pathological-staged T3 N3 esophageal cancer.

Locally advanced esophageal cancer is associated with poor long-term survival. Pre- and post-treatment stages may differ because of neoadjuvant therapy and inaccuracies in staging. The aim of this study was to determine the outcomes of patients staged with clinical T3 N3 and pathological T3 N3 carcinoma of the esophagus and determine differences between the groups. Consecutive patients from a single unit between 2010 and 2018 were included with either clinical (cT3 N3) or pathological (pT3 N3) esophageal cancer. Outcomes were compared between patients that underwent esophagectomy with or without neoadjuvant treatment and those patients staged cT3 N3 treated non-surgically (NSR). Patients were staged using the TNM 8. This study included 156 patients, 63 patients were staged cT3 N3 initially and had NSR treatment, only three of these had radical treatment. Of the remaining 93 patients who underwent esophagectomy, 34 were initially staged as cT3 N3, 54 were found to be pT3 N3 having been staged earlier initially, and five were unchanged before and after treatment. Median overall survival (OS) for surgical cT3 N3 patients was significantly longer than pT3 N3 and NSR (median: NR vs 19 vs 8 months, P < 0.001). Twenty-seven patients with cT3 N3 had lower staging following treatment, while three had a higher stage. T3 N3 disease carries a poor prognosis. Within this cohort, cT3 N3 disease treated surgically has a high 5-year OS suggesting possible over-staging and stage migration due to neoadjuvant therapy. Those not having surgery, have a dismal prognosis. The impact of neoadjuvant treatment cannot be predicted and, current staging modalities may be inaccurate. Clinical stage should be used with caution when counseling patients regarding management and prognosis.

Systematic review of the use of endo-luminal topical negative pressure in oesophageal leaks and perforations.

Topical negative pressure is widely used in the management of superficial wounds. The use of this technology in the management of oesophageal perforations is becoming increasingly common. This systematic review aims to capture available evidence about its use in this setting. Medline and Embase were searched using MeSH terms and free text: esophageal perforation; esophageal injury; vacuum assisted closure; vacuum therapy device; esophagus; wounds penetrating; esophageal perforation; wound healing; negative pressure wound therapy. Searches were carried out between April and November 2015. Case series, cohort trials and controlled trials were included. Additional studies were found by hand searching reference lists. Eleven studies met the inclusion criteria with 180 patients. Nine of the studies were case series and two were retrospective comparisons of negative pressure with stents or clips. Healing of the perforation occurred in 163/179 patients and the overall mortality was 12.8%. Compared with published data on mortality from oesophageal perforation, the application of negative pressure appears to be beneficial. The studies are, however, limited to case series and retrospective cohort studies. The number of patients in each study is small and in the absence of randomized trials demonstrating a lack of bias firm conclusions cannot be made.

British Military surgical key performance indicators: time for an update?

BACKGROUND: Key performance indicators (KPIs) are metrics that compare actual care against an ideal structure, process or outcome standard. KPIs designed to assess performance in deployed military surgical facilities have previously been published. This study aimed to review the overall performance of surgical trauma care for casualties treated at Role 3 Camp Bastion, Medical Treatment Facility, Afghanistan, in light of the existing Defence Medical Services (DMS) KPIs. The secondary aims were to assess the utility of the surgical KPIs and make recommendations for future surgical trauma care review. METHODS: Data on 22 surgical parameters were prospectively collected for 150 injured patients who had primary surgery at Camp Bastion between 1 May 2013 and 20 August 2013. Additional information for these patients was obtained using the Joint Theatre Trauma Register. The authors assessed data recording, applicability and compliance with the KPIs. RESULTS: Median data recording was 100% (IQR 98%-100%), median applicability was 56% (IQR 10%-99%) and median compliance was 78% (IQR 58%-93%). One KPI was not applicable to any patient in our population. Eleven KPIs achieved >80% compliance, five KPIs had 80%-60% compliance and five KPIs had <60% compliance. Recommendations are made for minor modifications to the current KPIs. CONCLUSION: 78% compliance with the DMS KPIs provides a snapshot of the performance of the surgical aspect of military trauma care in 2013. The KPIs highlight areas for improvement in service delivery. Individual KPI development should be driven by evidence and reflect advances in practice and knowledge. A method of stakeholder consultation, and sequential refinement following evidence review, may be the right process to develop the future set of DMS KPIs.

Fratura da coluna toracolombar do tipo explosão em T12/L1/L2 / Burst fracture of the thoracolumbar spine in T12, L1 and L2

Realizou-se um estudo retrospectivo e comparativo dos resultados obtidos em 63 pacientes que sofreram fratura da coluna toracolombar do tipo explosão, em T12, L1 e L2, dos quais 34 foram tratados pela técnica de Harrington e 29 receberam a fixação de Roy-Camille, sendo estas as técnicas hoje superadas. Em 48 deles havia indicação de descompressão medular, os outros 15 submeteram-se apenas à redução e fixação. Foram agrupadas as diferentes variáveis para análise da casuística. A fixação de Roy-Camille apresentou menor taxa de soltura de material de síntese, menor numero de pseudartrose, menor quebra de instrumental, menor redução do espaço discal e fixação mais curta. Evidenciou-se grande n£mero de complicações, justificando realmente a opção por instrumentação mais moderna e eficaz. Apesar das vantagens observadas com a fixação de Roy-Camille, os estudos bioestatísticos e comparativos das duas técnicas mostraram resultados satisfat¢rios para a época e sem importantes disparidades.

Obstacles and opportunities in designing cancer control communication research for farmworkers on the Delmarva Peninsula.

Little is known about the incidence of cancer among farmworker populations or about effective strategies for communicating with farmworkers about cancer prevention. Some studies suggest that farmworkers may have unusually high incidences of skin and cervical cancers. With these two cancers as the focus, a group of interviewers, researchers, and health communication specialists set out to create, implement, and evaluate a cancer control demonstration project geared toward farmworkers. In 1994, a situation analysis was conducted to identify constraints and opportunities for providing farmworkers with cancer control information and services. The situation analysis provided valuable information to aid in developing intervention and evaluation strategies. This paper outlines how and why the situation analysis was conducted and what was learned with regard to the farmworker population on the Delmarva Peninsula. Living conditions and the local availability of cancer control services are described. Obstacles to conducting research and interventions with farmworkers are highlighted. Based on what was learned, recommendations are made for designing cancer control research and intervention for farmworkers.

Bilateral compressive optic neuropathy secondary to bilateral sphenoethmoidal mucoceles.

We have presented a rare case of bilateral posterior sphenoethmoidal sinus mucoceles with bilateral compressive optic neuropathy. While the duration of compression was variably present over a 10-month period, there were nevertheless significant improvements in visual acuity of the right eye and visual fields bilaterally following extensive optic nerve decompression.

Inhibitors of polyamine biosynthesis. 4. Effects of alpha-methyl-(+/-)-ornithine and methylglyoxal bis(guanylhydrazone) on growth and polyamine content of L1210 leukemic cells of mice.

L1210 leukemic cells of mice were incubated for a period of two generations in the presence of either alpha-methyl-(+/-)-ornithine, an inhibitor of ornithine decarboxylase, or methylglyoxal bis(guanylhydroazone), an inhibitor of S-adenosylmethionine decarboxylase. alpha-Methyl-(+/-)-ornithine produced a 50% decrease in spermidine levels, reduced putrescine to nondetectable levels, and caused a slight increase in spermine levels of the cells. However, DNA content of the cell suspension was not altered by alpha-methyl-(+/-) ornithine. Thus putrescine and 50% of the cellular content of spermidine are not essential for DNA synthesis in these cells. Methylglyoxal bis(guanylhydrazone) produced a large increase inputrescine levels, the same decrease in spermidine levels as did alpha-methyl-(+/-)-ornithine, and approximately a 45% decrease in spermine levels. These changes were accompanied by a large decrease in the DNA content of the cell suspension. Since the two inhibitors caused a similar decrease in spermidine levels, it is unlikely that the inhibition of DNA synthesis by methylglyoxal bis(guanylhydrazone) is a result of a decrease in the cellular levels of spermidine. Rather, it seems likely that methylglyoxal bis(guanylhydrazone) inhibits DNA synthesis through a mechanism other than a decrease in polyamine levels.

Determination of diamines and polyamines in tissues by high-pressure liquid chromatography.

The 5-dimethylaminonaphthalene-1-sulfonyl (dansyl) derivatives of 1,2-diaminoethane, 1,3-diaminopropane, 1,4-diaminobutane (putrescine), spermidine and spermine have been separated by high-pressure liquid chromatography on a Micropak CN-10 column using a programmed solvent gradient elution. The column eluate is monitored by a fluorescence detector. This method has been used to determine the levles of putrescine, spermidine and spermine in various tissues of rats and in L 1210 leukemic cells of mice grown in culture. The technique is sufficiently sensitive to detect ca. 40pmoles of putrescine and ca. 20 pmoles of spermidine and spermine, is quite specific and can be performed rapidly.

Retention cysts of Cowper's duct.

Retention cysts arising from obstructed Cowper's ducts are rare lesions of the anterior urethra. Five cases are reported, 3 in male infacts and 2 in young boys. In children and adults the cysts may cause dysuria, urinary frequency, or urinary retention. The etiology of Cowper's duct cysts remains uncertain, but both congenital and acquired cysts have been described. The radiographic findings are characteristic: a smooth, rounded filling defect is seen on the ventral wall of the proximal bulbous urethra during voiding cystourethrography. After fulguration of the cyst, urethrography may reveal reflux into a dilated Cowper's duct.

Potential inhibitors of polyamine biosynthesis. 2. alpha-Alkyl- and benzyl-(+/-)-ornithine.

Alpha-Methyl-(+/-)-ornithine hydrochloride was not a substrate for ornithine decarboxylase from rat prostate glands. It produced equal inhibition of ornithine decarboxylase obtained from rat prostate glands, spleens of mice inoculated with L1210 leukemic cells, and regenerating rat liver indicating its lack of selectivity for any of these tissues. In these three tissues the inhibition was competitive with L-ornithine. A number of alpha-alkyl- and alpha-aralkyl-substituted analogs of (+/-)-ornithine were synthesized and evaluated in vitro as inhibitors of the enzyme L-ornithine decarboxylase obtained from prostate glands of rats. These compounds were obtained by the reaction of alkyl iodide or benzyl bromide with the anion obtained by treatment of 3-(benzalimino)piperidin-2-one with sodium hydride. The following alpha-substituted analogs of (+/-)-ornithine were obtained: ethyl, n-propyl, n-butyl, n-hexyl, n-octyl, and benzyl. The synthesized compounds were found to be much less active than alpha-methyl-(+/-)-ornithine as competitive inhibitors of ornithine decarboxylase in vitro. The most active compound in the series was alpha-n-octyl-(+/-)-ornithine which was 60-fold less active than alpha-methyl-(+/-)-ornithine and the least active analog was alpha-n-butyl-(+/-)-ornithine which was 270-fold less active than the alpha-methyl-(+/-)-ornithine.