(Dis)concordance of comorbidity data and cancer status across administrative datasets, medical charts, and self-reports.

BACKGROUND: Benchmarking outcomes across settings commonly requires risk-adjustment for co-morbidities that must be derived from extant sources that were designed for other purposes. A question arises as to the extent to which differing available sources for health data will be concordant when inferring the type and severity of co-morbidities, how close are these to the "truth". We studied the level of concordance for same-patient comorbidity data extracted from administrative data (coded from International Classification of Diseases, Australian modification,10th edition [ICD-10 AM]), from the medical chart audit, and data self-reported by men with prostate cancer who had undergone a radical prostatectomy. METHODS: We included six hospitals (5 public and 1 private) contributing to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic) in the study. Eligible patients from the PCOR-Vic underwent a radical prostatectomy between January 2017 and April 2018.Health Information Manager's in each hospital, provided each patient's associated administrative ICD-10 AM comorbidity codes. Medical charts were reviewed to extract comorbidity data. The self-reported comorbidity questionnaire (SCQ) was distributed through PCOR-Vic to eligible men. RESULTS: The percentage agreement between the administrative data, medical charts and self-reports ranged from 92 to 99% in the 122 patients from the 217 eligible participants who responded to the questionnaire. The presence of comorbidities showed a poor level of agreement between data sources. CONCLUSION: Relying on a single data source to generate comorbidity indices for risk-modelling purposes may fail to capture the reality of a patient's disease profile. There does not appear to be a 'gold-standard' data source for the collection of data on comorbidities.

The internal jugular vein valve may have a significant role in the prevention of venous reflux: evidence from live and cadaveric human subjects.

INTRODUCTION: The internal jugular vein valve (IJVV), which is situated just above the termination of the internal jugular vein, is the only valve between the heart and the brain. This means that it plays a role in the prevention of cephalad flow of venous blood. If the IJVV is damaged or becomes incompetent, increase in intrapleural pressure could result in raised intracranial pressure. Additionally, the jugular venous pulse (JVP) is used clinically to estimate right atrial pressure, a functional IJVV may prevent accurate estimation of the JVP. OBJECTIVES: To describe the presence and the competence of the IJVV in post-mortem and live human subjects. DESIGN - setting and methods: The anatomical appearance of the IJVV from 30 cadavers was studied. Competence was checked by measuring maximum hydrostatic pressure before reflux occurred through the valve. The function of the valve was evaluated in 25 live subjects using colour duplex scanning. RESULTS: The IJVV was present in all cadavers just before its termination (60 IJVVs from 30 subjects). The valve was bicuspid in most cases (93%). The competence of 41 IJVVs was checked of which only three (7%) were found to be incompetent. All IJVVs in live subjects were found to be competent. CONCLUSION: This study confirms that a functional IJVV is present just above the termination of the internal jugular vein. The IJVV may therefore prevent reflux of venous blood from the right atrium into the internal jugular vein.

The swollen leg: is it deep vein thrombosis? The experience of a tertiary referral center in Sri Lanka.

INTRODUCTION: The role played by deep vein thrombosis (DVT) as a cause of leg swelling in Sri Lanka is unknown. PURPOSE: To study the prevalence of proximal DVT, value of risk factors and clinical features and attitudes of clinicians towards diagnosis and treatment of DVT among those presenting with leg swelling as the main complaint. DESIGN: Prospective consecutive referrals to the University Surgical Unit, Colombo, over 10 months starting in January 1998. INCLUSION CRITERIA: DVT suspects with swollen legs. EXCLUSION CRITERIA: Varicose veins, leg ulceration and generalized oedema. METHODS: Color duplex scanning of the proximal deep veins and the superficial veins to detect occlusion and reflux. Information on previous diagnoses and treatment were obtained from the medical records. RESULTS: 63/137 (45%) had deep venous causes for oedema. Fever with rigors and inguinal lymphaedenopathy were strongly predictive of non DVT causes. Filariasis is the first diagnosis and DVT is considered late among the outpatients. CONCLUSIONS: DVT is a common cause of leg swelling among those referred.

Cytohistologic features of invasive micropapillary carcinoma in a young female.

Invasive micropapillary carcinoma (IMPC) is a recently reported variant of breast carcinoma in women. There has been only a single report describing the cytologic features of IMPC in the literature. We report on the cytohistologic features of IMPC with diffuse involvement of two quadrants of the breast and axillary lymph node metastases in a 32-yr-old female. The cytologic appearance of IMPC was characterized by high cellularity, marked cell discohesion, and epithelial cells forming aggregates, morules, and angular and papillary clusters without fibrovascular cores and showing high nuclear/cytoplasmic ratio, irregular nuclear contours, and finely stippled chromatin. Occasional psammoma bodies were noted. Histologic examination showed a pure IMPC composed of clusters, morules, and aggregates of malignant epithelial cells surrounded by distinctly clear spaces separated by thin fibrovascular septa. The tumor involved both inner quadrants and axillary lymph nodes. A primary tumor elsewhere, particularly in the ovaries, was excluded. The patient has been disease-free 38 mo after the initial diagnosis.

Pregnancy following renal transplantation in Sri Lanka.

OBJECTIVE: To assess the outcome and complications of pregnancy following renal transplantation in Sri Lanka. METHODS: Ten pregnancies following transplantation managed between January 1993 and July 1999 by the University Obstetrics and Gynaecology Unit, De Soysa Hospital for Women, Colombo were reviewed. RESULTS: Five women had planned pregnancy with an average duration from transplantation to conception of 2.3 (+/- 0.2) years; five had an unplanned pregnancy within 12 months of transplantation. All were treated with immunosuppressives, with none developing rejection. In the planned pregnancy group, 3 developed pregnancy induced hypertension and 3 impaired glucose tolerance. All delivered mature healthy babies with an average birth weight of 2.6 (+/- 0.3) kg. In the unplanned group, 1 developed cholestatic jaundice and delivered a growth retarded baby at 36 weeks. Another developed severe pulmonary oedema at 34 weeks (due to a past myocardial infarction) resulting in a fresh stillbirth. Two others has mid-trimester foetal deaths complicating severe diabetes mellitus. The conception at 3 months after transplantation developed diabetes mellitus and pregnancy induced hypertension, and delivered a live growth retarded baby. None had deterioration of renal function. CONCLUSION: Although a successful outcome is possible with stringent pre-pregnancy selection, maternal morbidity and foetal wastage can be high in those without.

Fine needle sampling without aspiration.

Four hundred and ten thyroid nodules, 127 breast lumps and 43 lymph nodes were sampled and analyzed to compare the classical aspiration (ASP) technique with the non aspiration needle jab (NASP) technique. The adequacy of cellularity, significant blood staining and the discomfort felt by the patient were assessed and statistically analyzed. The non aspiration technique was found to be superior to the classical aspiration technique for fine needle sampling of thyroid in all aspects. However, for breast lesions, while the discomfort felt and the staining with blood was less with the non aspiration technique, the overall cellular yield was unsatisfactory. The adequacy of cellular yield was, however, comparable for malignant breast lesions with either technique. For lymph node sampling, both techniques showed equivalent results with regard to the cellularity but, the NASP technique was superior in other aspects. Although the overall patient discomfort and blood staining was significantly less, the adequacy of the cellularity was influenced by the site and the nature of the lesion. Thus it can be concluded that the technique needs to be selected depending on the anatomic site, the clinical situation, the personal experience and the preference of the operator.

Emergency femoral arteriography in lower limb vascular trauma.

There are difficulties in obtaining emergency arteriographic evaluation in lower limb vascular trauma even in the best centres in the world. Ten emergency room arteriograms were performed at the new Accident Service of the General Hospital, Colombo from February to October 1992 by the vascular team, using a venous cannula and improvised tubing systems. The indications were, absence of distal pulses with closed injury to the limb, previous attempts at repair, injury to the limb at more than one site and multiple shrapnel injury. A traumatic arteriovenous communication was shown in one of the arteriograms. Unnecessary exploration of the artery was prevented by the demonstration of a patent femoropopliteal segment in two cases. The average delay caused by this procedure was less than one hour, which compares well with centres in the West. Provision of an arteriogram kit at the Accident Service will help to overcome practical problems.

Aspiration cytology of breast lumps.

The results of 287 aspirations performed on palpable breast lumps over a period of 20 months are presented. This is the first documentation of a Sri Lankan experience of this technique. The cytological assessment showed 52 malignant, 149 benign, 8 atypical, 6 suspicious and 72 inadequate aspirates. All lesions with a cytological diagnosis of malignancy were confirmed by histological assessment (False positives = 0). Histological follow up in 96 of the 149 cytologically benign lesions showed that 2 were malignant, giving a false negative rate of 2.1%. Three atypical lesions (37.5%) and four suspicious (66.2%) and 10 inadequate aspirates (13.7%) were also malignant.