IBD-PODCAST Spain: A Close Look at Current Daily Clinical Practice in IBD Management.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity. AIMS: The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact. METHODS: IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396). RESULTS: A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control. CONCLUSION: Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD.

Death certification in patients whose primary treatment for oral and oropharyngeal carcinoma was operation: 1992-1997.

The aim of this study was to report the cause and place of death of patients with oral cancer as recorded by death certification and their survival with regard to comorbidity and age. From the departmental head and neck oncology database, 322 patients were identified with previously untreated oral and oropharyngeal squamous cell carcinoma diagnosed between 1992 and 1997 inclusive. Three-hundred were matched with the Office for National Statistics (ONS) and copies of death certificates generated on 6 March 1999. Of the 286 patients primarily treated by operation, 203 were alive and 83 had died. In 56 (68%), oral cancer was a contributory factor to the patient's death. Patients with a medical history recorded on their admission for operation had similar survival curves compared to those having no problems recorded. Although most patients (n= 46 55%) died in hospital, only 13 (16%) died in the Regional Maxillofacial Unit. Almost half of those patients who died were not recorded as dead on the departmental oncology database. This study shows that it is useful to link with the ONS to obtain accurate data on date and place of death. The death certificate also gives a useful indication of the cause of death and this seems unrelated to preoperative comorbidity.

Swedish nurses' estimation of fatigue as a symptom in cancer patients--report of a questionnaire.

Many studies show that chronic fatigue is the most frequently reported symptom related to cancer and its treatment. In order to evaluate the problem in Sweden, a questionnaire was mailed to 442 registered nurses in the autumn of 1995 with the aim of determining cancer nurses' views of the nature and causes of cancer-related fatigue and which, if any, nursing interventions they employed in the management of this problem. The response rate was 49%. The responses showed that these nurses regarded fatigue as the most common symptom in cancer patients, but there were few established nursing interventions. Also, nurses wanted further education and tools for evaluation of fatigue, its causes and treatment.

Early detection of anastomotic leaks after low anterior resection of the rectum.

PURPOSE: Lysozyme destroys the mucopolysaccharide chains of the cell wall of gram-negative bacteria. It is a component of local defense and is formed in macrophages. Determination of lysozyme content in the wound seems to be the most reliable method for early recognition of wound infection. METHODS: In a prospective randomized study on the efficacy of single vs. double staple technique in anterior rectum resection, the effluent from the pelvic drain was examined with regard to its lysozyme activity. RESULTS: Lysozyme activity in drained secretion remained stable for more than 24 hours at room temperature. When the single staple technique was used, enzyme activity was sharply increased (mean, 9.6 mg/dl on the first postoperative day) compared with the double staple technique (mean, 5.5 mg/dl on the first postoperative day). The difference was statistically significant (P < 0.0001). Mean lysozyme activity was increased in those patients with clinically (18 mg/dl on the first postoperative day) and radiologically (15.3 mg/dl on the first postoperative day) detected dehiscence (P < 0.0001). CONCLUSION: Lysozyme determination may be reproduced by detection of enzyme stability in drained secretion. Determination of lysozyme content seems to be a new possibility for early recognition of anastomotic dehiscence.

Distribution of marker-Y chromosome containing cells in different tissues of a Turner mosaic patient with mixed gonadal dysgenesis.

We here describe a 12-year-old girl with numerous Turner stigmata and virilized external genitalia. Chromosome analysis of PHA stimulated lymphocytes using different banding techniques revealed a 45,X/46,X,+mar Turner mosaicism with the prominent marker present in about 90% of the blood cells. A PCR-based analysis using a set of 9 STS from different regions of the human Y chromosome indicated the presence of Y chromosomal material with a deletion breakpoint most likely within deletion interval 6. Because of the risk of gonadoblastoma for Turner patients carrying Y chromosomal material, and clinical indications of functional testicular tissue, a gonadectomy in addition to surgical correction of the external genitalia was performed. The histological analysis of the gonads showed a mixture of testicular tissue and ovarian stroma, thus indicating mixed gonadal dysgenesis. Fibroblasts from skin and different parts of the gonads were cytogenetically analyzed and showed a variable distribution of the Y-derived marker between 4% in skin, 11-31% in gonadal tissue and up to 90% in peripheral lymphocytes.

[Bronchiolitis obliterans organizing pneumonia with acute respiratory insufficiency]. / "Bronchiolitis obliterans organizing pneumonia" mit akuter respiratorischer Insuffizienz.

A 22-year-old woman was hospitalized because of fever of 39 degrees C and increasing dyspnoea. The chest radiograph demonstrated coarse confluent opacities bilaterally. Despite antibiotic treatment the condition deteriorated acutely after 2 days. All efforts to find an infectious agent, including immunological tests, were unsuccessful. Artificial ventilation became necessary because of increasing respiratory failure with an arterial oxygen partial pressure of 56 mm Hg, CO2 of 41 mm Hg and a respiratory rate of 60/min. Histological examination of a transthoracic lung biopsy revealed bronchiolitis obliterans organizing pneumonia, which was treated with prednisolone. The initial dose was 500 mg/d, gradually reduced to 12.5 mg/d over 2 weeks. The clinical and radiological findings improved markedly after 2 days and the patient discharged herself after 3 weeks and there was no follow-up.

[Differential diagnosis of tumor-like changes in the external ear]. / Zur Differentialdiagnose tumorförmiger Ohrmuschelveränderungen.

Tumor-shaped auricular affections are rare. Usually the case history is little abounding, the symptoms are trifling in contrast to the local findings and the etiology is frequently settled in the borderdistrict to the internal medicine, the dermatology and the neurology. Therefore differential diagnosis can meet with difficulties. Basic on a relevant observation indications are given of the delimitation of such tumor-shaped auricular affections from each other.

[Induction of puberty by pulsatile luteinizing hormone releasing hormone (LH-RH)--therapy in a boy with Kallmann syndrome]. / Einleitung der Pubertät durch pulsatile Luteinisierungshormon-Releasing-Hormon (LH-RH)--Therapie bei einem Jungen mit Kallmann-Syndrom.

To induce the lacking development of puberty, a male patient with hypothalamic hypogonadism and anosmia (Kallmann's syndrome) was treated with pulsatile application of gonadotropin-releasing hormone (GnRH) to imitate the endogenous secretion of GnRH. The low-dose pulsatile GnRH treatment which was reported to be successful by various authors proved to be ineffective when administered to our patient subcutaneously as well as intravenously. Serum testosterone levels comparable to the lower normal values in adults and continuous progress of pubertal development were only achieved after increasing the dosage from 2 to 8 micrograms per pulse by subcutaneous application. The course of therapy is reported in detail.

[Results of renal transplantation in childhood]. / Ergebnisse der Nierentransplantation im Kindesalter.

37 renal allografts were performed on 27 children of 2-16 years of age. In 67% function was maintained for more than a year. At the beginning of 1981, 13 children had functioning grafts with a median serum-creatinine level of 1.8 +/- 1.2 mg%. 4 children had a functioning graft for more than 7 years. All children with functioning grafts were fully rehabilitated. Hence, renal transplantation is the optimal therapy in chronic renal insufficiency in childhood.

Rhabdomyosarcoma of the bile ducts.

Rhabdomyosarcoma is a rare malignant neoplasm of the biliary tract. Including all the historical recent probable, and established cases that are carefully classified by Hayes and Synder, only 24 cases have been reported to date. Because of the extreme rarity of this tumor in this location, correct diagnosis was not made until second laparotomy or autopsy in several reported cases. The present report describes a child who recently underwent excision of such a tumor at our institution.