Mean number of lymph nodes in colonic cancer specimen: possible quality control index for surgical performance.

UNLABELLED: Lymphatic involvement in colonic cancer explains the need for extensive lymphadenectomy for intended curative operations. Surgical skills may determine the actual extent of the procedure and indirectly the number of lymphnodes (LN) removed from each specimen. MATERIAL AND METHODS: We looked on a series of 329 consecutive patients with colonic cancer who underwent a standardized procedure including extensive lymphadenectomy. The main endpoints were survival as well as the number of LN and the mean number of RESULTS: Differences in Kaplan-Meyer survival curves between average and high performance colectomies have been identifled for right colectomies both in stage II (85.7% vs 64.7%) as well in stage III (71.4% vs 56.5% 5-year survival), and also in stage II for segmental colectomies (85.7% vs 78.9%), showing a definitive advantage in survival for patients operated by surgeons with a mean LN retrieval above cutoff values. CONCLUSIONS: our study suggests that the mean number of LN retrieved from the surgical specimen can be used to evaluate surgical performance in colonic cancer, and may reflect in postoperative survival. However care should be taken when extrapolating these data as surgeon-independent factors such as protocols for LN harvesting may be different in other institutions and will influence results.

Correlation between Congo red binding as virulence marker in Shigella species and Sereny test.

Six variants of nutrient agar were tested in order to chose the suitable media for Congo red binding test. Trypto-soy Eiken, T.S.A - Cantacuzino Institute and B.T.S.D. (a medium prepared with Difco ingredients) are appropriate to distinguish between virulent Crb+ and avirulent Crb- strains. Congo red binding was compared with Sereny test using 25 Shigella strains. The strains were inoculated onto trypto-soy agar Eiken plates with 0.01% Congo red, incubated 24 hours at 37 degrees C. A number of each kind (Crb+ and Crb-) of colonies developed by every strain was subcultured on nutrient agar and Sereny test was performed with these cultures. As expected, all 84 Crb+ colonies in vivo tested, produced keratoconjunctivitis. In the case of Crb- colonies a proper correlation with Sereny negative test was observed in 57 out of 73 colonies (78.2%) to which 10.9% (8 out of 73) less virulent (evoking illness in only one of the two inoculated eyes) colonies may be added. As our results confirmed that loss of pigmentation was consistently accompanied by loss or diminishing of virulence, we consider that Congo red binding may be used as an alternative of in vivo test for establishing the virulence of Shigellae in the routine practice of microbiology laboratories which usually are not provided with cell cultures or animals. Its reduced cost is an important advantage, too.

Identification of Shiga-like toxin in Escherichia coli strains, etiological agents of diarrheal disease.

Shiga-like toxin presence, in 20 E. coli strains, etiological agents of diarrheal diseases, is studied by preparing extracts at +4 degrees C, in the presence of chloroform and by i.v. inoculation in mice. In 4 out of 20 strains, Shiga-like toxin in high titres was identified. Most of the strains presented an inconstant and variable production of Shiga-like toxin in comparison with Shigella dysenteriae type 1 (Shiga) reference strain. The authors also confirm the existence of Shiga-like toxin under 2 forms (neutralizable with Shiga antitoxic serum and non-neutralizable). The importance of the obtained results is further discussed from the point of view of pathogeny and diagnosis of the infections produced by these germs.

[The role of maternal care in reducing perinatal and neonatal mortality in developing countries]. / Rolul îngrijirilor materne în reducerea mortalitatii perinatale si neonatale în tarile în curs de dezvoltare.

PIP: Neonatal and perinatal mortality is directly linked to the health of the mother immediately after birth. Numerous international scientific meetings among them the 45th session of the Mixed Committee of WHO in January 1985, have dealt with this issue. Maternal mortality is defined as the death of the mother 42 days after delivery. Perinatal mortality includes delayed fetal death and early neonatal death. Delayed fetal death often occurs in newborns weighing under 1000 gm. Usually perinatal mortality is defined as the number of delayed fetal deaths and early neonatal deaths among those weighing over 1000 gm/1000 live births. The neonatal mortality level corresponds to the number of deaths of children born alive at 4 weeks/1000 live births. Postnatal mortality means the death of children born live up to 1 year of age. Infant death means death under age 1. Infant mortality level is defined as deaths of infants that survive for a whole year. The major problems of infant health include diarrheal diseases normally requiring vaccination and malnutrition during the first month of life. In Bangladesh, Lesotho, and Mexico, the mortality level ranges between 32.8 to 135/1000 live births. Neonatal mortality makes u 42-63% of infant mortality. The perinatal period comprises the period between 28th week of pregnancy and the 7th day of life. Diarrhea and respiratory infections contribute to perinatal mortality. In developing countries, maternal mortality related to pregnancy of women aged 15-45 occurs most often. 2-10 maternal deaths/1000 live births to as high as 20/1000 are current estimates. In Nigeria, among adolescents, the rate is 50-70 deaths/1000 live births. 124 perinatal deaths that occurred in 1970 and 1973 in India were analyzed yielding these percentages: insufficient birth weight 32%, asphyxia 19%, obstetrical trauma 18%, congenital anomalies 7%, tetanus of the newborn 3%, and others 21%. In Africa and Southeast Asia tetanus-related neonatal mortality amounts to 10-30/1000 live births and the total annual toll reaches 750,000 to 1 million globally mostly because of nonsterile instruments. 90% of tetanus incidence in Romania was eradicated by vaccination. Preventive measures can reduce mortality: education of women on health and hygiene, avoidance of heavy labor during pregnancy, family planning services, aseptic techniques, vaccination against tetanus and other infectious diseases, chemical prophylaxis against malaria, improved obstetrical care, consolidated support system, and community participation.^ieng

The Mures-Uzhgorod-Debrecen study: a comparison of hospital stroke services in Central-Eastern Europe.

Stroke mortality is extremely high in Central-Eastern European countries. The high rate of risk factors and differences in health care services might be among the factors resulting in high stroke morbidity and mortality in this region. As only few prospectively collected information are available from this region, we decided to evaluate some characteristics of stroke services in neurological departments of a Romanian, a Ukrainian and a Hungarian city in the framework of the Mures-Uzhgorod-Debrecen comparative epidemiological study. We registered demographic data, the absence or presence of the most important risk factors, and clinical signs on admission and at discharge. We recorded the application of various diagnostic methods, stroke treatment and recommendations for secondary prevention. Follow-up is planned after 30 days and after 1 year. The paper summarizes the methodology of this prospective epidemiological study of stroke patients hospitalized in neurological departments in Târgu Mures, Uzhgorod and Debrecen, three Central-Eastern European cities in Romania, Ukraine and Hungary, respectively.