RESUMEN
BACKGROUND: Colorectal cancer is a frequent cause of mortality in Western countries, including Italy, where a definite screening policy has not yet been adopted. It is likely that most patients with colorectal cancer refer, first of all, to their primary care physician at onset of symptoms. AIM: To perform a survey on the approach, of primary care physicians, to patients with symptoms suggesting the presence of colorectal cancer. METHODS: A total of 280 consecutive symptomatic patients without previous diagnosis of organic colon disease or recent colon investigation in whom, after consulting, 159 primary care physicians in Lazio (Italy) prescribed colonoscopy or double-contrast barium enema. RESULTS: Most frequent presenting symptoms were lower abdominal pain (79.6%), bloating (59.6%), constipation (47.8%), diarrhoea (30.3%), iron deficiency anaemia (24.6%), change in bowel habits (20.3%) and weight loss (15%). Colonoscopy and barium enema were equally advised by physicians to rule out the presence of cancer (56% versus 44%, P = ns). Cancer was found in 14.6% of patients. Age > 50 years and iron deficiency anaemia were the only independent variables associated with colorectal cancer (Odds ratios 9.0 and 8.8 at multivariate analysis, respectively). CONCLUSION: The symptom-based selection criteria used by primary care physicians have been shown to be scarcely effective. Colonic investigation should be requested, irrespective to the symptoms, in patients aged > 50 years with iron deficiency anaemia.
Asunto(s)
Adenoma/epidemiología , Adenoma/etiología , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/etiología , Adenoma/diagnóstico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Sulfato de Bario , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Medios de Contraste , Recolección de Datos , Diagnóstico Diferencial , Enema , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/etiología , Italia/epidemiología , Masculino , Persona de Mediana Edad , Médicos de Familia , Pautas de la Práctica en Medicina , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Estadística como Asunto , Factores de TiempoRESUMEN
Recent 13C nuclear magnetic resonance (13C-NMR) studies in the anesthetized rat and perfused liver suggest that hepatic glycogen is simultaneously synthesized and degraded, even during combined hyperglycemia and hyperinsulinemia. The presence of glycogen turnover would confound efforts to study glycogen repletion with the use of tracer methods during feeding, particularly if the liver is not glycogen-depleted. To ascertain whether glycogen turnover occurs during normal feeding, we measured liver uptake of glucose in 10 awake, healthy, postabsorptive dogs with long-term arterial, portal, and hepatic venous catheters before and for 3 hours after a meal of either glucose alone (1.5 g/kg) or glucose supplemented with crystalline amino acids (0.7 g/kg); the meal was labeled with D-[3-3H]glucose and [U-14C]alanine. Liver glycogen level was measured in biopsies obtained before and at 180 minutes after the meal. The postabsorptive liver glycogen content was 4.3 +/- 0.9 g/100 g, and net hepatic glucose release averaged 1.8 +/- 0.3 mg/min/kg. Over the 3 hours following feeding, the liver took up glucose (0.37 +/- 0.14 and 0.33 +/- 0.16 g/kg body weight in dogs receiving glucose and glucose with amino acids, respectively). At 3 hours, glycogen synthesis from D-[3-3H]glucose in the two groups averaged 0.24 +/- 0.09 and 0.22 +/- 0.05 g/kg, or approximately 15% of the ingested glucose load. 14C-glucose also was found in liver glycogen, demonstrating ongoing hepatic gluconeogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Ingestión de Alimentos/fisiología , Glucógeno Hepático/metabolismo , Administración Oral , Alanina/administración & dosificación , Alanina/metabolismo , Animales , Biopsia , Glucemia/análisis , Radioisótopos de Carbono , Perros , Ayuno/fisiología , Femenino , Glucosa/administración & dosificación , Glucosa/metabolismo , Hígado/patología , Glucógeno Hepático/análisis , Masculino , Factores de Tiempo , TritioRESUMEN
The article refers to autotransfusion experience in a patient affected by lymphoma (not Hodgkin type), who reached surgery for haemoperitoneum caused by the spontaneous rupture of the spleen. Considering the pathology, this method brought unpredictable variations in the hemochrome thus leading to a deep reflection on the limitations of the use of autotransfusion.