Developing a conceptual framework for flexible surge capacity based on complexity and collaborative theoretical frameworks.

OBJECTIVES: This study aims to develop a theoretical framework for the flexible surge capacity, inspired by existing surge capacity, complexity theory, and collaborative theoretical frameworks, and discuss its implementation and use in emergencies. STUDY DESIGN: This was a descriptive study. METHODS: Theoretical frameworks for surge capacity, the complexity and resilience theory, and collaboration were reviewed and combined to develop a theoretical framework for the flexible surge capacity, incorporated with standard practical tools used in disaster and emergency management as interconnecting collaborative factors. RESULTS: The expanded number of disasters, public health emergencies, and the emergence of new risks and vulnerabilities indicate a complex situation and an apparent need to revisit the core of preparedness for unexpected incidents. Four crucial elements as parts of surge capacity, that is, staff, stuff, space, and systems, need to be considered in the planning and managing disasters and emergencies. Within the ordinary contingency plans, primary and secondary surges are planned and prepared. However, there are situations where those surges may not exist or are impossible to deliver. In such situations, available community resources should be used, described as flexible surge capacity. The flexible surge capacity framework incorporates a balanced and innovative process of integrating various resilience factors in complex incidents and collaboration among multiagency organizations. CONCLUSIONS: The flexible surge capacity theoretical framework was developed. Nonetheless, further studies on the willingness of the medical and non-medical organizations to partake in the flexible surge capacity system are required.

Community-based response to the COVID-19 pandemic: case study of a home isolation centre using flexible surge capacity.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the concept of flexible surge capacity to reduce the burden on hospitals by focussing on community resources to develop home isolation centres in Bangkok, Thailand. STUDY DESIGN: A qualitative study consisted of observational and semi-structured interview data. METHODS: The development and activities of home isolation centres were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analysed and categorised based on the practical elements necessary in disaster and emergency management. RESULTS: Data were categorised into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: (1) coordination and collaboration; (2) staff engagement; (3) responsibility clarification; and (4) sustainability. Safety presented two subcategories: (1) patients' information privacy and treatment; and (2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organisation (WHO) guidelines and hospital operations. Several supply- and patient-related challenges were identified and managed during centre development. CONCLUSIONS: The use of community resources, based on the flexible surge capacity concept, is feasible under restricted circumstances and reduced the burden on hospitals during the COVID-19 pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of emergencies' aetiology.

Rhino-orbito-cerebral mucormycosis: patient characteristics in pre-COVID-19 and COVID-19 period.

BACKGROUND: Rhino-orbito-cerebral-mucormycosis (ROCM), a rare and potentially fatal disease was seen in increasing numbers during the COVID-19 pandemic. This study describes and compares the patient characteristics and outcomes in COVID-19 associated mucormycosis (CAM) and non-COVID-19 mucormycosis (non-CAM). METHODOLOGY: CAM patients (24 cases) were recruited from the COVID-19 period and non-CAM (24 controls) from the pre-COVID-19 period. Clinical data of the CAM group was collected retrospectively with 3 month outcomes prospectively. The non-CAM group data was collected retrospectively. Patient characteristics were compared and risk factors for mortality in ROCM were assessed. RESULTS: Orbital symptoms [altered vision, restricted eye movements, ptosis] and intracranial involvement were higher in CAM patients on presentation. Similarly, the radiological involvement of orbit (orbital apex, superior orbital fissure) and intracranial cavity (intracranial thrombosis, cavernous sinus) was also higher in CAM patients. Newly detected diabetes was found only in CAM patients (29.2%). Although univariate analysis suggested an increased mortality risk in ROCM patients with orbital involvement, the multivariate analysis showed no increased risk with any of the parameters assessed, including COVID-19 positivity. CONCLUSIONS: Compared to the non-CAM, the disease presentation was severe in CAM with higher frequency of orbital and intracranial involvement. However, with early detection and treatment, the short term survival was comparable in both groups.

Epidemiology and pathophysiology of malignancy in common variable immunodeficiency?

Common variable immunodeficiency (CVID) is a diagnostic category of primary immunodeficiency (PID) which may present with heterogeneous disorders including recurrent infections, autoimmunity, granulomatous diseases, lymphoid and other types of malignancies. Generally, the incidence of malignancy in CVID patients is around 1.5-20.7% and usually occurs during the 4th-6th decade of life. Non-Hodgkin lymphoma is the most frequent malignancy, followed by epithelial tumours of stomach, breast, bladder and cervix. The exact pathological mechanisms for cancer development in CVID are not fully determined; however, several mechanisms including impaired genetic stability, genetic predisposition, immune dysregulation, impaired clearance of oncogenic viruses and bacterial infections, and iatrogenic causes have been proposed to contribute to the high susceptibility of these patients to malignancies.

Multifunctional Aspects of Mechanical and Electromechanical Properties of Composites Based on Silicone Rubber for Piezoelectric Energy Harvesting Systems.

Energy harvesting systems fabricated from rubber composite materials are promising due to their ability to produce green energy with no environmental pollution. Thus, the present work investigated energy harvesting through piezoelectricity using rubber composites. These composites were fabricated by mixing titanium carbide (TiC) and molybdenum disulfide (MoS2) as reinforcing and electrically conductive fillers into a silicone rubber matrix. Excellent mechanical and electromechanical properties were produced by these composites. For example, the compressive modulus was 1.55 ± 0.08 MPa (control) and increased to 1.95 ± 0.07 MPa (6 phr or per hundred parts of rubber of TiC) and 2.02 ± 0.09 MPa (6 phr of MoS2). Similarly, the stretchability was 133 ± 7% (control) and increased to 153 ± 9% (6 phr of TiC) and 165 ± 12% (6 phr of MoS2). The reinforcing efficiency (R.E.) and reinforcing factor (R.F.) were also determined theoretically. These results agree well with those of the mechanical property tests and thus validate the experimental work. Finally, the electromechanical tests showed that at 30% strain, the output voltage was 3.5 mV (6 phr of TiC) and 6.7 mV (6 phr of MoS2). Overall, the results show that TiC and MoS2 added to silicone rubber lead to robust and versatile composite materials. These composite materials can be useful in achieving higher energy generation, high stretchability, and optimum stiffness and are in line with existing theoretical models.

Elevating Supercapacitor Performance of Co3O4-g-C3N4 Nanocomposites Fabricated via the Hydrothermal Method.

The hydrothermal method has been utilized to synthesize graphitic carbon nitride (g-C3N4) polymers and cobalt oxide composites effectively. The weight percentage of g-C3N4 nanoparticles influenced the electrochemical performance of the Co3O4-g-C3N4 composite. In an aqueous electrolyte, the Co3O4-g-C3N4 composite electrode, produced with 150 mg of g-C3N4 nanoparticles, revealed remarkable electrochemical performance. With an increase in the weight percentage of g-C3N4 nanoparticles, the capacitive contribution of the Co3O4-g-C3N4 composite electrode increased. The Co3O4-g-C3N4-150 mg composite electrode shows a specific capacitance of 198 F/g. The optimized electrode, activated carbon, and polyvinyl alcohol gel with potassium hydroxide were used to develop an asymmetric supercapacitor. At a current density of 5 mA/cm2, the asymmetric supercapacitor demonstrated exceptional energy storage capacity with remarkable energy density and power density. The device retained great capacity over 6k galvanostatic charge-discharge (GCD) cycles, with no rise in series resistance following cyclic stability. The columbic efficiency of the asymmetric supercapacitor was likewise high.

Smart Textile Flexible MnCo2O4 Electrodes: Urea Surface Modification for Improved Electrochemical Functionality.

Surface microstructure modification of metal oxides also improves the electrochemical performance of metal oxide nanoparticles. The present investigation demonstrates how varying the urea molar content during the hydrothermal process altered the surfaces of MnCo2O4 nanoparticles. Successive increases of 0.1 M in urea concentration transformed the surface shape of MnCo2O4 nanoparticles from flower-like to sheet-like microstructures. Excellent electrochemical performance of MnCo2O4 nanoparticles was demonstrated in an aqueous 1 M KOH electrolyte. The improved MnCo2O4 nanoparticles have been employed to develop an asymmetric supercapacitor (ASC). The ASC device exhibits an energy density of 13 Wh/kg at a power density of 553 W/kg and a specific capacitance of 29 F g-1 at a current density of 4 mA/cm2. The MnCo2O4 nanoparticle electrode demonstrates remarkable electrocatalytic activity in both HER and OER. The MnCo2O4 electrode shows overpotential for HER and OER at 356 mV and 1.46 V, respectively. The Tafel slopes for HER and OER of the MnCo2O4 electrode are 356 mV/dec and 187 mV/dec, respectively.

Ni3V2O8 Marigold Structures with rGO Coating for Enhanced Supercapacitor Performance.

In this work, Ni3V2O8 (NVO) and Ni3V2O8-reduced graphene oxide (NVO-rGO) are synthesized hydrothermally, and their extensive structural, morphological, and electrochemical characterizations follow subsequently. The synthetic materials' crystalline structure was confirmed by X-ray diffraction (XRD), and its unique marigold-like morphology was observed by field emission scanning electron microscopy (FESEM). The chemical states of the elements were investigated via X-ray photoelectron spectroscopy (XPS). Electrochemical impedance spectroscopy (EIS), Galvanostatic charge-discharge (GCD), and cyclic voltammetry (CV) were used to assess the electrochemical performance. A specific capacitance of 132 F/g, an energy density of 5.04 Wh/kg, and a power density of 187 W/kg were demonstrated by Ni3V2O8-rGO. Key electrochemical characteristics were b = 0.67; a transfer coefficient of 0.52; a standard rate constant of 6.07 × 10-5 cm/S; a diffusion coefficient of 5.27 × 10-8 cm2/S; and a series resistance of 1.65 Ω. By employing Ni3V2O8-rGO and activated carbon, an asymmetric supercapacitor with a specific capacitance of 7.85 F/g, an energy density of 3.52 Wh/kg, and a power density of 225 W/kg was achieved. The series resistance increased from 4.27 Ω to 6.63 Ω during cyclic stability tests, which showed 99% columbic efficiency and 87% energy retention. The potential of Ni3V2O8-rGO as a high-performance electrode material for supercapacitors is highlighted by these findings.

Modulating the Configurations of "Gel-Type" Soft Silicone Rubber for Electro-Mechanical Energy Generation Behavior in Wearable Electronics.

Electro-mechanical configurations can be piezo-electric transducers, triboelectric generators, electromagnetic induction, or hybrid systems. Our present study aims at developing energy generation through the piezoelectric principle. Gel-type soft SR with Shore A hardness below 30 was used as a versatile material for an elastomeric substrate. Also, multi-wall carbon nanotube (MWCNT), and diatomaceous earth (DE) were used as reinforcing fillers. This "gel-type" soft SR has crosslinking polymer networks with silicone encapsulated within its structure. Mechanical properties such as modulus or stretchability are of utmost importance for such devices based on "gel-type" soft. From the experiments, some of the mechanical aspect's values are summarized. For example, the stretchability was 99% (control) and changes to 127% (3 phr, MWCNT), 76% (20 phr DE), and 103% (20 phr hybrid). From electro-mechanical tests, the output voltage was 0.21 mV (control) and changed to 0.26 mV (3 phr, MWCNT), 0.19 mV (20 phr DE), and 0.29 mV (20 phr hybrid). Moreover, from real-time biomechanical human motion tests in "gel-type" soft-based composites, a relationship among output voltage from machine to human motions was established. Overall, these configurations make them promising against traditional portable devices such as batteries for small power applications such as mobile phones.

Tailoring Triple Filler Systems for Improved Magneto-Mechanical Performance in Silicone Rubber Composites.

The demand for multi-functional elastomers is increasing, as they offer a range of desirable properties such as reinforcement, mechanical stretchability, magnetic sensitivity, strain sensing, and energy harvesting capabilities. The excellent durability of these composites is the key factor behind their promising multi-functionality. In this study, various composites based on multi-wall carbon nanotubes (MWCNT), clay minerals (MT-Clay), electrolyte iron particles (EIP), and their hybrids were used to fabricate these devices using silicone rubber as the elastomeric matrix. The mechanical performance of these composites was evaluated, with their compressive moduli, which was found to be 1.73 MPa for the control sample, 3.9 MPa for MWCNT composites at 3 per hundred parts of rubber (phr), 2.2 MPa for MT-Clay composites (8 phr), 3.2 MPa for EIP composites (80 phr), and 4.1 MPa for hybrid composites (80 phr). After evaluating the mechanical performance, the composites were assessed for industrial use based on their improved properties. The deviation from their experimental performance was studied using various theoretical models such as the Guth-Gold Smallwood model and the Halpin-Tsai model. Finally, a piezo-electric energy harvesting device was fabricated using the aforementioned composites, and their output voltages were measured. The MWCNT composites showed the highest output voltage of approximately 2 milli-volt (mV), indicating their potential for this application. Lastly, magnetic sensitivity and stress relaxation tests were performed on the hybrid and EIP composites, with the hybrid composite demonstrating better magnetic sensitivity and stress relaxation. Overall, this study provides guidance on achieving promising mechanical properties in such materials and their suitability for various applications, such as energy harvesting and magnetic sensitivity.

Revised workflow practices in the management of acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic.

OBJECTIVE: To document changes in evaluation protocols for acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic, and to analyse concordance between clinical and histopathological diagnoses based on new practice guidelines. METHODS: Protocols for the evaluation of patients with suspected acute invasive fungal sinusitis both prior and during the coronavirus disease 2019 period are described. A retrospective analysis of patients presenting with suspected acute invasive fungal sinusitis from 1 May to 30 June 2021 was conducted, with assessment of the concordance between clinical and final diagnoses. RESULTS: Among 171 patients with high clinical suspicion, 160 (93.6 per cent) had a final histopathological diagnosis of invasive fungal sinusitis, concordant with the clinical diagnosis, with sensitivity of 100 per cent, positive predictive value of 93.6 per cent and negative predictive value of 100 per cent. CONCLUSION: The study highlights a valuable screening tool with good accuracy, involving emphasis on 'red flag' signs in high-risk populations. This could be valuable in situations demanding the avoidance of aerosol-generating procedures and in resource-limited settings facilitating early referral to higher level care centres.

Clinical and Radiologic Findings of Acute Necrotizing Encephalopathy in Young Adults.

Acute necrotizing encephalopathy after an acute febrile illness, although initially described exclusively in the pediatric age group, has been recently shown to have an adult onset as well. In this study, we describe 10 patients (16 years of age or older) with acute necrotizing encephalopathy. In our study, bilateral thalamic involvement with the trilaminar pattern of diffusion restriction on MR imaging was the predominant finding seen in all of the patients reviewed. Ancillary findings of cerebral white matter, brain stem, and cerebellum involvement with sparing of the basal ganglia were also noted. A poorer outcome was observed in patients with a higher degree of thalamic involvement. The cause of an underlying infection was identified in 4 patients (dengue in 3 and influenza in 1). Overall, a sizeable portion of young adults with acute necrotizing encephalopathy have shown a poorer outcome, with dengue being an important underlying trigger in an endemic region.

Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients.

BACKGROUND: A trial in selected men suggested that antibiotic therapy could be an alternative to appendicectomy in appendicitis. This study aimed to evaluate antibiotic therapy in unselected men and women with acute appendicitis. METHODS: Consecutive patients were allocated to study (antibiotics) or control (surgery) groups according to date of birth. Study patients received intravenous antibiotics for 24 h and continued at home with oral antibiotics for 10 days. Control patients had a standard appendicectomy. Follow-up at 1 and 12 months was carried out according to intention and per protocol. RESULTS: Study and control patients were comparable at inclusion; 106 (52.5 per cent) of 202 patients allocated to antibiotics completed the treatment and 154 (92.2 per cent) of 167 patients allocated to appendicectomy had surgery. Treatment efficacy was 90.8 per cent for antibiotic therapy and 89.2 per cent for surgery. Recurrent appendicitis occurred in 15 patients (13.9 per cent) after a median of 1 year. A third of recurrences appeared within 10 days and two-thirds between 3 and 16 months after hospital discharge. Minor complications were similar between the groups. Major complications were threefold higher in patients who had an appendicectomy (P < 0.050). CONCLUSION: Antibiotic treatment appears to be a safe first-line therapy in unselected patients with acute appendicitis. REGISTRATION NUMBER: NCT00469430 (http://www.clinicaltrials.gov).

Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after laparoscopic cholecystectomy.

BACKGROUND: Postoperative pain experienced by patients who undergo laparoscopic cholecystectomy may aggravate surgical complications, prevent early discharge, and cause readmission. This study aimed to evaluate the effectiveness of an intraoperative intercostals neural blockade for the control of postoperative pain after laparoscopic cholecystectomy. METHODS: In a prospective, double-blinded, clinical trial, 61 patients classified as American Society of Anesthesiology (ASA) 1 and 2 undergoing laparoscopic cholecystectomy were randomized to receive only general anesthesia (control group, n = 30) or general anesthesia plus intraoperative intercostals neural blockade using 0.5% bupivacaine-adrenaline at the right side (intercostals group, n = 31). Postoperative pain was assessed according to a pain severity score using a subjective analog visual scale (VAS) 6, 12, and 24 h after the surgery. Systemic narcotic injection was available to all surgically treated patients postoperatively according to their demand. The history, pain severity score, and all postoperative data were recorded for each patient. RESULTS: The pain severity score was significantly higher in control group than in the intercostals group (p < 0.001), suggesting that patients who received intercostals neural blockade had less pain postoperatively than the control group. CONCLUSION: Intercostals neural blockade may safely be used to reduce the postoperative pain after laparoscopic cholecystectomy.

Non-medical aspects of civilian-military collaboration in management of major incidents.

PURPOSE: Disasters and major incidents demand a multidisciplinary management. Recent experiences from terrorist attacks worldwide have resulted in a search for better assessment of the needs, resources, and knowledge in the medical and non-medical management of these incidents and also actualized the need for collaboration between civilian and military healthcare. The aim of this study was to evaluate the impact of the civilian-military collaboration in a Swedish context with the main focus on its non-medical management. METHOD: An exercise, simulating a foreign military attack centrally on Swedish soil, was designed, initiated, and conducted by a team consisting of civilian and military staff. Data were collected prospectively and evaluated by an expert team. RESULTS: Specific practical and technical issues were presented in collaboration between civilian and military staffs. In addition, shortcomings in decision-making, follow-up, communication, and collaboration due to prominent lack of training and exercising the tasks and positions in all managerial levels of the hospital were identified. CONCLUSION: Current social and political unrests and terror attacks worldwide necessitate civilian-military collaboration. Such collaboration, however, needs to be synchronized and adjusted to avoid preventable medical and non-medical consequences. Simulation exercises might be one important source to improve such collaboration.

Electromagnetic therapy for treating venous leg ulcers.

BACKGROUND: Leg ulceration is a common, chronic, recurring condition. The estimated prevalence of leg ulcers in the UK population is 1.5 to 3 per 1000. Venous ulcers (also called stasis, or varicose ulcers) comprise 80 to 85% of all leg ulcers. Electromagnetic therapy is sometimes used as a treatment to assist the healing of chronic wounds such as venous leg ulcers. OBJECTIVES: To assess the effects of electromagnetic therapy on the healing of venous leg ulcers. SEARCH STRATEGY: For this first review update, we searched the Cochrane Wounds Group Specialised Register (last searched October 2005); CENTRAL (The Cochrane Library 2005, Issue 4); MEDLINE (1966 to October 2005); EMBASE (1980 to October 2005); and CINAHL (1982 to October 2005). SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy or other treatments. DATA COLLECTION AND ANALYSIS: For the original review, details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. A second reviewer checked data extraction. Meta-analysis was applied to combine the results of trials where the interventions and outcome measures were adequately similar. For this first update, two reviewers independently scrutinized the results of the search to identify relevant RCTs and obtained full reports of potentially eligible studies. In the case of disagreements, a final decision was made either after discussion between two reviewers or consultation with a third party (a member of the Cochrane Wounds Group). MAIN RESULTS: This update identified no new trials. A total of three eligible RCTs were identified by the original review. Two trials compared the use of electromagnetic therapy with sham therapy and one trial compared it with standard topical treatments. One trial found a difference in healing rates of borderline statistical significance between electromagnetic therapy and sham therapy, although the direction of treatment effect was consistently in favour of electromagnetic therapy, the difference was not statistically significant. AUTHORS' CONCLUSIONS: There is currently no reliable evidence of benefit of electromagnetic therapy in the healing of venous leg ulcers. Further research is needed.

Electromagnetic therapy for treating pressure ulcers.

BACKGROUND: Pressure ulcers are defined as areas "of localized damage to the skin and underlying tissue caused by pressure, shear, friction and/or the combination of these". In the UK, pressure ulcers occur in 5 to 32% of District General Hospitals people and in 4 to 7% of people in community settings. Electromagnetic therapy, in which electrodes produce an electromagnetic field across the wound, may improve healing of chronic wounds such as pressure ulcers. OBJECTIVES: To assess the effects of electromagnetic therapy on the healing of pressure ulcers. SEARCH STRATEGY: For this first update, we searched the Cochrane Wounds Group Specialised Register (last searched October 2005); CENTRAL (The Cochrane Library 2005, Issue 4); MEDLINE (1966 to October 2005); EMBASE (1980 to October 2005); and CINAHL (1982 to October 2005). SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy, or other (standard) treatment. DATA COLLECTION AND ANALYSIS: For this first update, two authors independently scrutinized the results of the search to identify relevant RCTs and obtained full reports of potentially eligible studies. For the original review, details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. Data extraction was checked by a second author. Meta-analysis was applied to combine the results of trials when the interventions and outcome measures were sufficiently similar. MAIN RESULTS: This update identified no new trials. Two RCTs were identified for inclusion in the original review (total of 60 participants). One was a three-armed study comparing electromagnetic therapy with electromagnetic therapy in combination with standard therapy, and with standard therapy alone, on 17 female and 13 male with grade II and III pressure ulcers. The other study compared electromagnetic therapy with sham therapy in 30 male participants with a spinal cord injury and a grade II or grade III pressure ulcer.Neither study found a statistically significant difference between the healing rates of pressure ulcers in people treated with electromagnetic therapy compared with those in the control group. AUTHORS' CONCLUSIONS: The results provide no evidence of benefit in using electromagnetic therapy to treat pressure ulcers. However, the possibility of a beneficial or harmful effect cannot be ruled out, due to the fact that there were only two included trials both with methodological limitations and small numbers of participants. Further research is recommended.

Occurrence and physico-serological properties of potato virus S (PVS) in Iran.

1818 collected samples of potato plant showing virus infection symptoms from 85 fields were tested for PVS infection using DAS-ELISA. Average of infection to this virus varied from 0 to 100%. Least infection was belonging to fields with new introduced varieties. On the other hand native and old introduced cultivars showed heavy infection. In field condition, PVS infected plants didn't show very obvious symptoms, so some infected plants may be missed in field sample collecting. The physical properties of 3 isolates, Avaj, Stanboly and Agria No 15 were determined. TIP 55-60 degrees C, DEP 10(-3) and Liv measured 3-4 days. Ouchterlony agar double diffusion test using SDS was useful for virus detection and precipitation lines didn't show any spur between isolates, although isolates differs slightly in symptomatology. SDS-Page and Western blotting methods used successfully for virus detection and determining and measuring viral protein components.

Mortality associated with pheochromocytoma in a large Swedish cohort.

BACKGROUND: The aim of the present study was to report the risk of death in a national cohort of patients with aPC (adrenal PC) and their risk of developing a second tumour. METHODS: Using the National Cancer Registry, 481 patients (222 men and 259 women) with aPC in Sweden (1958-1997) were identified. Autopsy-based diagnoses were excluded. As control group the entire Swedish population was used and the risk of death in patients after diagnosis of aPC was compared with the normal risk taking age, sex and calendar year into account. The risk for a second tumour disease after diagnosis of aPC was also calculated. RESULTS: Patients with aPC had an increased tumour-related mortality after diagnosis of aPC. For both men and women this mortality was four times higher than for controls. Liver/biliary tract and CNS tumours in men; and malignant melanoma and uterine cervical cancer in women were significantly over-represented in the cohort of patients with aPC. CONCLUSION: Patients with aPC run an increased risk of developing additional cancers. Surveillance strategies may thus be necessary for these patients.