Who is responsible for inadequate lymph node retrieval after colorectal surgery: surgeon or pathologist?

BACKGROUND: Many factors have been described influencing survival of patients with colorectal cancer. The most important prognostic factor is lymph node involvement. The National Comprehensive Cancer Network indicates that at least 12 lymph nodes (LN12) must be retrieved for proper staging and treatment planning. The surgeon and the pathologist influence the number of retrieved lymph nodes. METHODS: We retrospectively reviewed all patients with diagnosis and subsequent surgery for colorectal cancer from January 2004 to January 2010 at Gulhane Military Medical Academy in Ankara, Turkey. We investigated the relationship between LN 12 and the independent variables of tumour size, lymph node involvement, metastasis, age, gender, surgeon, pathologist, surgical specimen length, tumour stage, and localization. Statistical analysis utilized the Shapiro-Wilk test, interquartile range, Mann-Whitney test, chi-square and chi-square likelihood ratio tests, and Kruskal-Wallis nonparametric variance analysis. In order to identify influencing factors for retrieval of lymph nodes, multiple linear regression was performed. In order to identify the direction and extent of effects of these influencing factors, logistic regression was performed. OR (Odds Ratio) and 95% CI (Confidence Interval) of the OR were calculated. RESULTS: There were 223 study patients, 134 with colon cancer and 89 with rectal cancer. There was no statistical significance in terms of age, gender, cancer type and postoperative tumour size, number of metastatic lymph nodes > 4, or LN12 (p > 0.05). Statistical significance was found between surgeons and LN12, the number of operations and LN12 (p < 0.001), and pathologists and LN12 (p = 0.049). CONCLUSIONS: Harvesting an adequate number of lymph nodes is crucial for patients with colorectal cancer in terms of staging and planning further treatment modalities such as adjuvant chemotherapy. Multidisciplinary collaboration between surgeons and pathologists is vital for optimal patient outcomes.

Subjective sleep quality of cancer patients.

PURPOSE: to determine the quality of sleep, to locate the reasons for sleep disturbances and to define strategies overcoming sleep disturbances of cancer patients. METHODS: 175 cancer patients were included in this study. Data were collected using the Pittsburgh Sleep Quality Index (PSQI); a demographic data form and two open-ended questions on the reasons and coping strategies for sleep disturbances were filled in. RESULTS: the mean sleep quality score was 9.46 ± 4.669. The reasons given by patients for sleep disturbances were mostly cancer diagnosis (61.71%), adverse effects of therapy (58.85%), and financial problems (36.00%). Most patients (83.82%) used no pharmacologic strategies like lifestyle practices (64.25%), behavioral practices (21.25%), and biologic treatments (4.34%). Total PSQI scores of female patients were significantly higher compared to male patients, indicating poor sleep quality (Z=3.189; p=0.001). There was no statistically significant difference between age, education, illness duration, types of cancer and total PSQI scores (p>0.05). CONCLUSION: This research implied that cancer patients had poor sleep quality. Healthcare professionals should assess the sleep quality of cancer patients and solve this problem in a holistic perspective in order to provide a supportive environment during the caregiving process.

Habituation of auditory event-related potentials in patients with Behcet's disease.

Behcet's disease is a progressive and/or relapsing-remitting multisystem inflammatory disorder. Involvement of the central nervous system occurs in 10%-29% of cases with Behcet's disease. The aim of the present study was to assess the effect of repetitive auditory stimulations on event-related potentials (ERP) in patients with Behcet's without neurologic manifestations. The study was performed in 14 patients with Behcet's disease and 14 healthy volunteers. ERPs were recorded from Fz, Cz and Pz. The auditory ERPs test was continued until 20 artefact-free rare tones were averaged, which was accepted as one trial block. After six blocks were obtained in a sequential manner, the test was completed. According to the results of the present study, P300 latency changed in different manners over trial blocks in the two groups. P300 latency values showed a progressive increase in the controls; however this was not determined in the Behcet's group. Thus, habituation was not observed in the patient group. Because of the lack of habituation related to P300 latency, it may be thought that there is an insidious pathologic process in Behcet's disease without neurologic manifestation.

Kangal hot spring with fish and psoriasis treatment.

The effect of "Kangal Hot Spring with Fish" in the treatment of psoriasis is investigated. The study was carried out on 87 patients with psoriasis vulgaris and the patients were evaluated by a dermatologist for 21 days. The evaluation of the disease was performed using PASI (Psoriasis Area and Severity Index) scores. Recurrences were investigated in the patient population, who had been previously treated in the same hot spring. The first examination scores were significantly higher than the scores of the 3, 6, 9, 12, 15 and 21 days after treatment (p < 0.01). Longer remission periods, when compared to the topical corticosteroid treatment, expressed by the 35 patients previously treated in hot spring (p < 0.01). Spa therapy under observation of a dermatologist may be effective and useful for psoriasis vulgaris patients.