Changes in screening behaviors and attitudes toward screening from pre-test genetic counseling to post-disclosure in Lynch syndrome families.

The purpose of this study was to examine colonoscopy adherence and attitudes toward colorectal cancer (CRC) screening in individuals who underwent Lynch syndrome genetic counseling and testing. We evaluated changes in colonoscopy adherence and CRC screening attitudes in 78 cancer-unaffected relatives of Lynch syndrome mutation carriers before pre-test genetic counseling (baseline) and at 6 and 12 months post-disclosure of test results (52 mutation negative and 26 mutation positive). While both groups were similar at baseline, at 12 months post-disclosure, a greater number of mutation-positive individuals had had a colonoscopy compared with mutation-negative individuals. From baseline to 12 months post-disclosure, the mutation-positive group demonstrated an increase in mean scores on measures of colonoscopy commitment, self-efficacy, and perceived benefits of CRC screening, and a decrease in mean scores for perceived barriers to CRC screening. Mean scores on colonoscopy commitment decreased from baseline to 6 months in the mutation-negative group. To conclude, adherence to risk-appropriate guidelines for CRC surveillance improved after genetic counseling and testing for Lynch syndrome. Mutation-positive individuals reported increasingly positive attitudes toward CRC screening after receiving genetic test results, potentially reinforcing longer term colonoscopy adherence.

Mortality risk among individuals treated for alcohol use disorders: results of a longitudinal study from 1978 to 2016 in Northern Italy.

OBJECTIVE: The aim of this study was to examine the mortality trends and causes of death in Northern Italy in a cohort of a population of individuals treated for alcohol use disorder (AUD) over a 38-year follow-up period (1978-2016). MATERIALS AND METHODS: 6,198 patients attending eighteen centres for addiction treatment (CATs) for AUD were recruited. RESULTS: During the follow-up period, 19.5% of the whole cohort died. The crude mortality rates (CMRs) were elevated (21.34 x 1000 person-years [PY]), higher for men and increasing with age group. The CMRs were higher for all cancers, followed by digestive system diseases, diseases of the circulatory system, transport accidents, and suicide. The standardised mortality ratios (SMRs) were at least three times higher for women and for men, and they were more elevated in younger patients and have been falling since 2009. Multivariate analysis confirmed that the mortality risk was higher for males and increased with age and decreased over time. The patients' main characteristics changed over time and, along with a greater presence of women and non-natives, fewer marginalised people and more socially integrated people turned to CATs. CONCLUSIONS: The mortality risk in treated AUD is confirmed to be higher when compared with the general population, although it is decreasing. In addition, there is enough epidemiological data to assert that, independent of age and gender, the major causes of death in AUD patients are cancers, gastrointestinal disease, cardiovascular disease (CVD), and injuries.

Pain and motor function in carpal tunnel syndrome: a clinical, neurophysiological and psychophysical study.

OBJECTIVE: Patients with carpal tunnel syndrome (CTS) complain of motor symptoms. The study is aimed to understand which features are associated with the presence of motor symptoms in CTS. METHODS: We recruited 282 consecutive CTS patients. After selection, 129 patients (203 hands) were included. Patients were asked about the presence and severity of hand weakness (HW) and hand clumsiness (HC). They underwent a self-administered questionnaire on symptoms, clinical evaluation and neurographic study. Quantitative sensory testing (QST) was performed on the patients with unilateral right CTS. RESULTS: HW and HC may be found in 56 % and 48 % of CTS hands, respectively. HW was related to the severity of sensory symptoms (pain, numbness and tingling) but not to clinical-neurographic measures of median nerve involvement. HC was related to the severity of sensory symptoms and to the clinical-neurographic signs of motor but not sensory nerve damage. Motor symptoms were significantly more frequent in right hands. QST showed a relationship between the presence and severity of HW and HC and the warm threshold. CONCLUSIONS: Motor symptoms may be found in approximately half of CTS hands. Clinical and neurographic signs of median nerve motor damage appear to be poorly correlated to motor symptoms. The factor that can help reconcile the discrepancy between motor symptoms and motor signs is pain. Pain modulation on motor function may take place at various anatomical levels in CTS. Nociceptive C-fibers may be involved in pain-motor interactions finally leading to motor symptoms.

The Effect of Maize Hybrid on Biology and Life Table Parameters of the Trogoderma granarium (Coleoptera: Dermestidae).

The khapra beetle, Trogoderma granarium Everts (Coleoptera: Dermestidae), is a polyphagous pest that infests many stored grains and products. The effect of nine maize hybrids including 704, AR 89, AS 71, AS 77, BC 678, KSC 703, PL 472, SC 704, and Simax was studied on biology and life table parameters of T. granarium at controlled conditions (33 ± 1 °C, 65 ± 5% RH, and a photoperiod of 14:10 [L:D] h). According to the results of this study, the immature period was the longest on BC 678 (56.79 ± SE: 1.51 d) and the shortest on PL 472 (39.90 ± 0.48 d). The highest values of fecundity and fertility were observed on PL 472 (67.95 ± 1.23 eggs and 74.81 ± 0.68%, respectively) and the lowest values were on BC 678 (40.00 ± 1.63 and 48.24 ± 1.35, respectively). The net reproductive rate (R0) of T. granarium ranged from 10.40 ± 0.11 offsprings on BC 678 to 30.43 ± 0.20 offsprings on KSC 703. The highest intrinsic rate of increase (rm) was for T. granarium reared on KSC 703 (0.0773 ± 0.0001 d-1), and the lowest was on BC 678 (0.0390 ± 0.0002 d-1). According to the obtained results, BC 678 is an unfavorable hybrid for population increase of T. granarium, which can be recommended to be grown in regions where the damage of T. granarium is considerable to minimize maize infestations by this pest.

Intention to learn results of genetic testing for hereditary colon cancer.

INTRODUCTION: This report investigates the correlates of intention to find out genetic test results in colorectal cancer patients undergoing genetic counseling and testing for hereditary nonpolyposis colon cancer. Specifically, we investigated whether intention to learn genetic test results was associated with sociodemographic factors, medical history, psychosocial factors, attitudes, beliefs, and decisional considerations related to genetic testing. MATERIALS AND METHODS: Among 342 colorectal cancer patients who went through an informed consent process and gave blood for genetic testing and who were eligible for a psychosocial questionnaire study, 269 cases completed a baseline interview. Patients were contacted in person during a routine clinic visit or by letter and follow-up telephone call and were interviewed either in person or by telephone. RESULTS: In univariate analysis, intention to learn test results was positively associated with income, quality of life, a belief that being tested will help family members prevent cancer, being worried about carrying an altered gene, and a belief that one has the ability to cope with test results. It was negatively associated with a belief that genetic counseling is too much trouble relative to the benefits. Intention also was positively associated with scales measuring the pros of learning test results and the pros of informing relatives about test results; it was negatively associated with the cons of learning test results. In multivariable analysis, the belief that testing would help family members prevent cancer, being worried about carrying an altered gene, and the pros of learning test results remained statistically associated with intention when other variables were included in the model. CONCLUSIONS: Our findings showed that the positive aspects of genetic testing were more strongly associated with intention than were the negative aspects. They also showed that persons who stated an intention to learn their genetic test results were more likely than persons who did not to affirm both the benefits and the importance of such testing. These results are consistent with the literature on psychosocial aspects of genetic testing for breast cancer.

Myocardial perfusion with rubidium-82. I. Measurement of extraction fraction and flow with external detectors.

Accurate measurement of the regional extraction of a diffusible radiopharmaceutical is essential for the quantifying of regional blood flow, and may also provide an important physiologic or diagnostic indicator of the cellular viability of an organ in man through external detection by positron emission tomography. However, extraction fraction of a diffusible tracer usually decreases as flow increases, and thus noninvasive methods for measuring flow are nonlinear unless the extraction fraction can be measured independently. This report describes the theoretical basis and documents the applicability of this theory for determining, with external detectors, the first-pass regional extraction fraction of rubidium-82 by the heart, following a single intravenous bolus injection of the tracer. Measurement of extraction fraction was found to be independent of flow, thereby making it possible to determine accurately with a single intravenous bolus injection of rubidium-82, the regional blood flow in the myocardium at up to five times normal resting flow.

Myocardial perfusion with rubidium-82. II. Effects of metabolic and pharmacologic interventions.

In order to validate a new method for quantifying coronary blood flow, we injected intravenously a bolus of rubidium-82 (Rb-82) into 28 open-chested dogs under a wide range of flow and physiologic conditions, using beta probes to monitor myocardial radioactivity. Extraction fraction and perfusion were measured using a functional model that separates the data into the free and trapped myocardial rubidium. Extraction and uptake of rubidium were lower during acidosis than during alkalosis and were unchanged by glucose-insulin, digoxin, or propranolol. Myocardial flow, as indicated by rubidium, correlated linearly with simultaneous measurements of flow by microspheres in the same sample volume over a wide range of flow (r = 0.97, n = 106, range 0.02-7.76 ml/min/g). Regional myocardial blood flow can be accurately determined using generator-produced Rb-82. Studies using current state-of-the-art, fast positron-emission tomographic cameras are required to determine the utility of this approach in man.

Oncology nurses' knowledge, practice, and educational needs regarding cancer genetics.

This study evaluated oncology nurses' knowledge of cancer genetics and related topics, and identified current practice patterns and perceived educational needs in this area. A 54-item study questionnaire was mailed to a random sample of 1,200 Oncology Nursing Society (ONS) members and 75 members of the ONS-Cancer Genetics Special Interest Group; 656 (51%) of those eligible responded. After exclusions, we analyzed 573 responses. Most respondents were Caucasian, female, and worked in hospital or outpatient settings. Half were staff nurses and 8% specialized in cancer genetics. Respondents with higher levels of nursing education or with continuing education in cancer genetics, who worked in positions other than staff nurses, and whose primary practice area was cancer genetics had significantly higher mean scores overall on questions measuring knowledge of cancer genetics and related areas. Higher perceived educational needs to improve knowledge or practice related to cancer genetics at basic, intermediate or advanced levels were associated with all or some of the following variables: lower education; hospital/ outpatient or managed care/private practice settings; lack of continuing education in cancer genetics, and positions other than advanced practice nurses. Although nearly half of the respondents had received patient inquiries regarding cancer genetics, only 35% were aware of referral resources and 26% had made such referrals. These findings may be used to develop targeted educational approaches that prepare oncology nurses to incorporate cancer genetics into any level of practice.

Human immunodeficiency virus-associated diarrhea and wasting in Zambia: selected risk factors and clinical associations.

A significant association was observed among human immunodeficiency virus (HIV)-positive adult cases in Lusaka, Zambia compared with HIV-negative controls for chronic diarrhea (68% versus 22%; P < 0.05), weight loss (54% versus 30%; P < 0.05), lymphadenopathy (44% versus 15%; P < 0.05), and skin eruption (33% versus 7%; P < 0.05). Among the HIV-positive children, a higher proportion had clinical evidence of tuberculosis when compared with HIV-negative children (8% versus 1%; P < 0.05). The study demonstrated an association between weight loss in HIV-positive adults and children and chronic diarrhea (odds ratio [OR] = 12.7, 95% confidence interval [CI] = 6.4-25.5; P < 0.001), persistent cough (OR = 7.2, 95% CI = 2.9-14.5; P < 0.001), and an age of 31-45 years (OR = 3.8, 95% CI = 1.8-8.3; P < 0.01). The factors associated with mortality in HIV positive patients included chronic diarrhea (OR = 7.4, 95% CI = 1.6-34; P < 0.01), and lymphadenopathy (OR = 3.89, 95% CI = 1.2-12.2; P < 0.04).

Myelography with metrizamide in the study of the lumbosacral tract.

The authors report their experience with Metrizamide (Amipaque) in the myelographic study of the lubosacrale) in the myelographic study of the lumbosacral tract. They compare their results with those obtained with other hydrosoluble contrast agents and correlate them with surgical findings. Metrizamide appears to be preferable to other hydrosoluble contrast agents due to its better radiological definition and because of the lower frequency of complications related to its use.

[Transhepatic percutaneous cholangiography with the Chiba needle in diagnosis of cholestasis]. / La colangiografia percutanea transepatica con ago di Chiba nella diagnostica delle colestasi.

A technique originally described by Okuda has been employed to study 78 patients suffering from cholestatic syndrome. Visualization of the biliary system was obtained in 70 (89.7%). Of these, 65 presented dilatation of the bile ways whereas in 5, the biliary tree was normal. The 8 cases in which no visualization was obtained were later examined with other techniques and 6 proved to be suffering from intrahepatic cholestasis. In patients with extrahepatic obstruction, the biliary system was visualized in 97%, while in intrahepatic cholestasis, the percentage was 45.5%. The main indication for PTC is the speed at which intrahepatic cholestasis can be distinguished from the extrahepatic type; in the second event, it always pinpoints the site of the impediment, though less frequently the nature of the lesion and its extent. No complications requiring emergency laparotomy were ever encountered. Percutaneous transhepatic cholangiography with Chiba needle is a simple, reliable inexpensive method which gives excellent results in the study of patients with cholestatic syndrome.

[Magnetic resonance imaging in non-Q wave infarction]. / Localizzazione con risonanza magnetica nucleare dell'infarto non Q.

The aim of this study is to evaluate magnetic resonance (MR) as a clinical tool to identify the site of non-Q myocardial infarction, when other techniques are inadequate. Ten patients underwent MR examination 3 - 15 days after the onset of symptoms. The examinations were performed with a General Electric 1.5 Tesla II unit, by means of ECG-gated MR imaging. The 10 patients were 35 to 56 years of age, 9 were men. In 5 patients it was the first myocardial infarction, in 5 patients the second. MR allowed us to identify the site of myocardial infarction: 5 inferior, 1 posterior, 2 postero-inferior, 1 apical, 2 subendocardial. Thus the MR examination is suggested in non-Q myocardial infarction to detect the site and the extent of the infarct. The MR is useful when echocardiography is technically non adequate or when it is not possible to identify regional wall motion abnormalities. We suggest to use this technique in patients with coronary artery bypass and in patients with multiple infarctions.

Feasibility of measuring first pass extraction and flow with rubidium-82 in the kidneys.

A feasibility study has been carried out to evaluate rubidium-82, a potassium analog and generator-produced positron emitter, for measuring renal blood flow using a first pass model. Seven acute dogs were studied with beta probes and positron emission tomography to understand the dynamics of rubidium-82 in the kidneys. Preliminary results show that first pass extraction fraction for rubidium-82 ranged from 80-95% with an average of 89%. During the 150 sec of data collection, approximately 44.5% of the injected dose is excreted in the venous side and 9.75% in the ureter. Flow measurements with rubidium-82 and microspheres correlated well with the average control flow of 5.0 ml/min/gm measured by microspheres and 4.5 ml/min/gm of flow measured by rubidium-82 using the first pass model.

Shigella sonnei strains isolated from U.S. summer students in Guadalajara, Mexico, from 1986 to 1992.

Plasmid DNA analysis and antibiotic susceptibilities were used to study strains of Shigella sonnei isolated from U.S. travelers to Guadalajara, Mexico, over a period of seven years (1986 to 1992). One hundred sixty-one isolates were analyzed. By the use of cluster analysis, eight different plasmid profiles were identified during this interval. At any point in time, three to seven different plasmid profiles were present in this population. The introduction of strains that carried a new plasmid with a molecular mass of 5.1 MDa was coincidental with an increase in isolation of S. sonnei in 1988. This new plasmid was present in 87.5% of the isolates that were resistant to chloramphenicol. Shigellosis in Guadalajara follows a pattern of hyperendemic transmission with transient peaks of high-frequency isolation of S. sonnei. This pattern results from the concurrent presence of a heterogeneous group of strains as opposed to the widespread transmission of one or a few clones.

Hydatid disease: MR imaging study.

Fifteen patients with hydatidosis, 13 with hepatic echinococcosis and two with isolated lesions of the spleen and the shoulder, were examined with magnetic resonance (MR) imaging. Of the 13 patients with hepatic hydatidosis, four had secondary peritoneal lesions, and one also had involvement of the dorsal spine. The presence of a hypointense rim and a multiloculated or multicystic appearance are distinctive features. When evaluating the viability of hydatid cysts the authors found that MR imaging findings were not particularly valuable, as the MR imaging signs (daughter cysts and detachment of the membranes) are rare and are also evident at computed tomography and ultrasound examinations. T2 measurements were not useful due to the wide range of values obtained. Despite these limitations, MR imaging is still an important technique in the study of echinococcosis to depict the presence of a rim as a characteristic sign and to obtain a complete anatomic evaluation.

Zaldaride maleate, an intestinal calmodulin inhibitor, in the therapy of travelers' diarrhea.

BACKGROUND: The therapeutic value of zaldaride maleate (Zm), an intestinal calmodulin inhibitor, was examined in patients with travelers' diarrhea, known to be caused by enterotoxigenic Escherichia coli (ETEC) and other bacterial agents. METHODS: One hundred seventy-six American students acquiring diarrhea in Mexico during the summer of 1991 were given Zm in doses of 5 mg, 10 mg, or 20 mg, or a matching placebo, four times a day for 48 hours. RESULTS: The duration of diarrhea was reduced by 53% in the group given the 20-mg Zm dose (overall P < 0.01). Curative antibiotics were required post-treatment only in the placebo and 5-mg Zm groups (P < 0.01). The number of unformed stools passed during 0-48 hours of therapy with the highest Zm dose was reduced compared with placebo by 36% for all subjects (P < 0.05), by 39% for ETEC diarrhea (NS), by 45% for those with any bacterial agents (NS), and by 38% for those without an identifiable bacterial agent (NS). CONCLUSIONS: The fact that a calmodulin inhibitor decreases the severity and duration of travelers' diarrhea has therapeutic implications and suggests that calmodulin and intracellular calcium may serve as mediators of diarrhea in bacterial enteric infection.

Zaldaride maleate (a new calmodulin antagonist) versus loperamide in the treatment of traveler's diarrhea: randomized, placebo-controlled trial.

The present study was undertaken to compare the efficacy of a new calmodulin antagonist, zaldaride maleate, with that of placebo or loperamide in persons with traveler's diarrhea. One hundred seventy-nine patients were randomized to receive loperamide (4 mg followed by 2 mg after each unformed stool), zaldaride maleate (20 mg four times per day), or placebo. During the initial 48 hours of therapy, zaldaride maleate decreased the number of unformed stools by 30% and the duration of illness by 23% when compared with placebo. Loperamide was superior to both zaldaride maleate and placebo during the initial hours of treatment. However, after 48 hours of treatment, loperamide and zaldaride maleate were equally efficacious, decreasing by > 50% the number of unformed stools passed in a 24-hour interval (P, not significant), and were both superior when compared with placebo (P < .0001 and P = .0048, respectively). The apparent superiority of loperamide early in the course of therapy appeared to be related to a loading-dose effect and not to any differences in antidiarrheal properties.

Bone marrow infiltration in hairy cell leukemia after interferon therapy detected by magnetic resonance imaging.

Magnetic resonance imaging (MRI) can detect bone marrow infiltration by neoplastic cells in many hematological malignancies. We studied 10 patients affected by hairy cell leukemia (HCL) and treated with interferon (IFN) with both MRI and bone marrow biopsy. T1-weighted MR scans of femurs and pelvis proved to be effective to score hairy cell infiltration, while less information was obtained from the study of the lumbar vertebral column. A good correlation (less than 10% difference) was noted between biopsy and MRI in over 90% of cases. MR scans showed, in general, a higher grade of infiltration. MR scan, however, can be useful for monitoring the course of HCL and the response to the treatment. Moreover, MRI evaluating a large amount of tissue, can detect a nodular type of infiltration which can be missed in biopsy specimens.