Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial.

AIM: Anastomotic leakage (AL) following abdominal surgery is a critical determinant of postoperative recovery, of which the aetiology is largely unknown. Interestingly, interventions aimed at reducing the inflammatory response and postoperative ileus (POI) have an unexpected effect on AL. The aim of this study was to investigate the relation of POI with inflammation and AL after colorectal resection. METHOD: A post hoc analysis of a prospective randomized controlled trial in which patients underwent a colorectal resection was performed. Patients undergoing a colorectal resection were stratified into having or not having POI. The incidence of AL and other clinical parameters was registered prospectively. Intestinal fatty acid binding protein (I-FABP, a marker for tissue damage) and the inflammatory response in plasma and colon tissue were determined. RESULTS: AL was present in nine of 43 patients in the POI group, and in one of 65 in the group without POI (P < 0.001). There was a significant association between POI and AL (OR 12.57, 95% CI: 2.73-120.65; P = 0.0005). Patients with POI had significantly higher plasma levels of soluble tumour necrosis factor receptor 1 (TNFRSF1A) at 4 h postoperatively (0.89 ng/l, interquartile range 0.56) than patients without POI (0.80 ng/l, interquartile range 0.37; P = 0.04) and higher plasma levels of C-reactive protein on the second day postoperatively (234 ± 77 vs 163 ± 86 mg/l; P = 0.001). Patients who developed AL had significantly higher plasma levels of I-FABP compared with patients without AL at 24 h after onset of surgery. CONCLUSION: POI is associated with a higher prevalence of AL and an increased inflammatory response.

Rapid regional perturbations to the recent global geomagnetic decay revealed by a new Hawaiian record.

The dominant dipolar component of the Earth's magnetic field has been steadily weakening for at least the last 170 years. Prior to these direct measurements, archaeomagnetic records show short periods of significantly elevated geomagnetic intensity. These striking phenomena are not captured by current field models and their relationship to the recent dipole decay is highly unclear. Here we apply a novel multi-method archaeomagnetic approach to produce a new high-quality record of geomagnetic intensity variations for Hawaii, a crucial locality in the central Pacific. It reveals a short period of high intensity occurring ~1,000 years ago, qualitatively similar to behaviour observed 200 years earlier in Europe and 500 years later in Mesoamerica. We combine these records with one from Japan to produce a coherent picture that includes the dipole decaying steadily over the last millennium. Strong, regional, short-term intensity perturbations are superimposed on this global trend; their asynchronicity necessitates a highly non-dipolar nature.

[Awareness in patients with mild cognitive impairment (MCI)]. / Ziekte-inzicht bij patiënten met een lichte cognitieve stoornis (MCI).

Patients with Mild Cognitive Impairment (MCI) run a higher risk for the development of a dementia. A disturbed awareness of deficits is a symptom of dementia and could be a predictor for the development of dementia in the assessment in the early stages of dementia. This awareness can be assessed by means of the discrepancy between the assessment of memory problems by patient and partner. In this study, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N) was used to assess the level of awareness. The results show that the discrepancy score (the difference between the IQCODE-Nscore of the patient and the IQCODE-Nscore of the partner) was significantly higher for the 61 MCI-patients when compared to the 40 healthy elderly (p = 0,01). This suggests a diminished awareness in MCI-patients. Analysis of the range of the MCI-group shows that this is true for 60% of the patients. Patients with a disturbed awareness score significantly lower on the MMSE (p < 0,01) than patients with an intact awareness.

Development of diurnal bladder control in severely and profoundly mentally handicapped residents.

At two time points, separated by an interval of 7 years, the level of diurnal bladder control of 198 severely and profoundly mentally handicapped individuals was assessed. A slight, but statistically significant increase of bladder control between the two time points was found. Difference scores of level of control were submitted to an ANOVA. Age at admission and duration of institutionalization proved to be related to individuals' level of diurnal bladder control. The results were discussed in relation to the use of toilet training procedures with mentally handicapped individuals.

Antibiotic sensitivity and synergism of 'penicillin-tolerant' Staphylococcus aureus.

15 Staphylococcus aureus strains were isolated from 15 patients with staphylococcal bacteremia. Eight of these strains were shown to be tolerant for cloxacillin. Cloxacillin-tolerant strains were also tolerant for most of the cephalosporins tested except for cephapirin. Strains were not tolerant for clindamycin and gentamicin. Penicillin-tolerant staphylococci showed a high degree of synergism between gentamicin and cloxacillin or cephalothin and gentamicin.