An epidemiological study evaluating the relationship of distance from a tertiary care cancer center to early detection of colorectal carcinoma.

OBJECTIVE: AJCC stage at diagnosis determines the treatment approach and indirectly predicts outcome in patients with colorectal carcinoma. The purpose of our study was to investigate whether there was a delay in diagnosis leading to a more advanced stage at diagnosis (which affects outcome) of patients with colorectal cancers because of distance from a referral center, after positive fecal occult blood testing (FOBT). DESIGN: Our retrospective observational study involved all cases of colonic and rectosigmoid cancers that were referred for an endoscopic procedure after an initial positive FOBT done as a part of routine screening in asymptomatic patients. PARTICIPANTS: Roger Maris Cancer Center and University of North Dakota School of Medicine and Health Sciences. RESULTS: Between the years 1996-2001, 178 subjects with biopsy-proven colon cancer and 80 patients with rectosigmoid cancer were included in our study. Pearson's correlation coefficients were constructed to look at the relationship between distance from a referral center (place where the diagnosis was made) and stage at diagnosis in patients with colonic and rectosigmoid malignancies. For the colon cancer group, the regression coefficient between AJCC stage at diagnosis and distance from the referral center was 0.013 and for rectosigmoid cancers it was 0.12. Even after stratifying distances into tertiles, the correlation coefficients did not show a significant relationship (0.04 for colon and 0.16 for rectosigmoid cancers). CONCLUSION: Distance (of residence) from a tertiary care center does not seem to be a barrier to early diagnosis of colorectal carcinoma and primary care providers in rural settings are referring patients appropriately leading to optimal outcomes.

Ineffectiveness of the measurement of 'routine' vital signs for adult inpatients with community-acquired pneumonia.

More frequent vital sign evaluation does not result in a statistically significant difference in survival or the number of transfers to the intensive care unit (for progression of disease) after adjusting for age, gender, duration of intravenous antibiotics and comorbid conditions.

Role of Helicobacter pylori infection in the incidence and clinical course of monoclonal gammopathy of undetermined significance.

OBJECTIVES: We aimed to evaluate the hypothesis that chronic antigenic stimulation is an etiological factor of monoclonal gammopathy of undetermined significance (MGUS) with special relevance to Helicobacter pylori infection. METHODS: We performed a retrospective, observational study. The diagnosis of MGUS was based on serum protein electrophoresis, serum IgM levels (<3 gr/dl), urinary M protein, a normal bone marrow biopsy, normal renal function, and a negative skeletal survey. H. pylori infection was ascertained by rapid urease testing and endoscopy with gastric biopsy for histology. Eradication of H. pylori was assessed by urea breath test and stool antigen assay 4 wk after completion of an appropriate treatment regimen. RESULTS: Sixty-nine patients with MGUS were included in the study. Of these, 57 had undergone evaluation for H. pylori infection for various GI symptoms. Thirty-nine of 57 patients (68.42%) with MGUS also had evidence of H. pylori infection. In 11 of these 39 patients (28.21%), eradication of H. pylori infection with an appropriate regimen led to normalization of the serum protein electrophoresis and resolution of the gammopathy. CONCLUSION: The results of our study give increased credibility to the theory that in a proportion of patients the pathogenesis of MGUS involves chronic antigenic stimulation and H. pylori is implicated. The search for H. pylori infection and an attempt to eradicate the bacterium in positive cases seem to be appropriate in patients diagnosed with MGUS.