Long-term outcomes for patients with peritoneal acellular mucinosis secondary to low grade appendiceal mucinous neoplasms

INTRODUCTION

Low grade appendiceal mucinous neoplasms (LAMN) are known to metastasise to the peritoneum resulting in pseudomyxoma peritonei (PMP). Literature suggests that the long-term outcome is dependent on the cellular grade of the peritoneal histology, less is known about the risk to patients with acellular mucinosis (AM) alone. This study aims to review long-term outcomes in patients with PMP treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC), whose peritoneal histology was AM secondary to LAMN.

METHODS

Pathological and treatment outcomes were collected from a prospectively maintained database between 2005 and 2019. Data was collected on patients with LAMN and AM diagnosed following CRS/HIPEC. A single institution performed the surgery and pathology reporting, samples reported by three different pathologists.

RESULTS

Of the 2079 patients with any appendiceal neoplasm referred between 2005 and 2019, 809 underwent CRS/HIPEC, 67 (8%) of those had PMP with purely AM secondary to a LAMN. In the AM group the median age was 59, 37 (55%) were female, follow up was for a median 39 (2-145) months. Inpatient mortality occurred in 1 patient (1.5%), disease specific mortality in 2 (3%), recurrence in 2 (3%) and disease progression in 1 (1.5%).

CONCLUSION

This study has identified AM secondary to LAMN as a low risk group for recurrence following CRS/HIPEC compared with epithelial pathology. Given such a low rate of recurrence we would recommend low intensity surveillance post CRS/HIPEC. Agreed standardised pathological assessment is required to exclude cellular material in specimens and diagnose AM.

Exploring the perceived medical ethics and law training needs of UK foundation doctors

Foundation doctors (FDs) encounter a wide range of ethical and legal issues during their first two years of work. Despite ethics being a key part of most modern undergraduate curricula, FDs can struggle with the issues they see. This study is based on results from an on-line survey answered by 479 UK FDs regarding their medical law and ethics learning needs, and their undergraduate training in this area. Over two-thirds stated they would wish to receive MEL training as an FD on self-discharge against medical advice (∼71%), sedating patients (∼70%), decision making in emergency medicine (∼67%), and withholding and withdrawing treatment (∼66%). Over half of all respondents want MEL training during their Foundation Programme on DNACPR orders (∼63%), dealing with patients with suicidal intent (∼59%), Mental Health Act (∼55%), Deprivation of Liberty Safeguards (∼54%), and end of life care (∼53%). We therefore propose a minimum curriculum for ethics and law training for FDs based on these topics, as well as cases brought by the FDs themselves.

Association between psychological distress and cancer type in patients referred to a psycho-oncology service

Psychological distress is common in patients with cancer and psychological well-being is increasingly seen as an important component of cancer care. The aim of this study was to examine the relationship between cancer type and subjective distress. The following data were collected from a database of consecutive psycho-oncology referrals to the Liaison Psychiatry service in Cork University Hospital from 2006 to 2015: demographics, cancer diagnosis, Distress Thermometer (DT) score. 2102 out of 2384 referrals were assessed. Of those assessed, the most common cancer diagnoses were breast (23%, n=486) followed by haematological (21%, n=445). There were significant difference in DT score between the different cancer types, (?2(13)=33.685, p=0.001, Kruskal-Wallis test). When adjusted for age, gender and whether or not the cancer was recently diagnosed, there was no significant association between cancer type and psychological distress. In conclusion, cancer type is not associated with level of distress in cancer.

Hospital infection society prevalence survey of Healthcare Associated Infection 2006: comparison of results between Northern Ireland and the Republic of Ireland

As part of the Third Healthcare Associated Infection (HCAI) Prevalence Survey of the United Kingdom and Ireland, HCAI point prevalence surveys were carried out in Northern Ireland (NI) and the Republic of Ireland (RoI). Here we explore the potential benefits of comparing results from two countries with different healthcare systems, which employed similar methodologies and identical HCAI definitions. Forty-four acute adult hospitals in the RoI and 15 in NI participated with a total of 11 185 patients surveyed (NI 3644 patients and RoI 7541). The overall HCAI prevalence was 5.4 and 4.9 in NI and the RoI, respectively. There was no significant difference in prevalence rates of HCAI, device-related HCAI or HCAI associated with bloodstream infection but there was a difference in meticillin-resistant Staphylococcus aureus-related HCAI (P = 0.02) between the two countries. There were significantly more urinary tract infections and Clostridium difficile infections recorded in NI (P = 0.002 and P < 0.001). HCAIs were more prevalent in patients aged >65 years and in the intensive care unit in both countries. HCAIs were also more prevalent if patients were mechanically ventilated, had had recent non-implant surgery (RoI) or had more recorded HCAI risk factors. This is the first time that HCAI prevalence rates have been directly compared between NI and the RoI. By closely examining similarities and differences between HCAI prevalence rates in both countries it is hoped that this will influence healthcare planning and at the same time reassure the public that HCAI is important and that measures are being taken to combat it.

Chromatin physics: Replacing multiple, representation-centered descriptions at discrete scales by a continuous, function-dependent self-scaled model

This commentary on the inspiring works and ideas by Langowski, Mangeol et al., Lee et al., Bundschuh and Gerland, Schiessel, Vaillant et al., Lesne and Victor, Claudet and Bednar, Fuks, Allemand et al., and Blossey, all appearing in this issue (Eur. Phys. J. E 19 (2006)), expresses our felt need of novel approaches to chromatin modeling.

LENS: A New Pulsed Neutron Source for Research and Education

A new pulsed neutron source is under construction at the Indiana University Cyclotron Facility (IUCF). Neutrons are produced via (p,n) reactions by a low-energy proton beam incident on a thin beryllium target. The source is tightly coupled to a cold methane moderator held at a temperature of 20 K or below. The resulting time-averaged cold neutron flux is expected to be comparable to that of the Intense Pulsed Neutron Source (IPNS) facility at Argonne National Laboratory. The initial experimental suite will include instrumentation for small angle neutron scattering (SANS), moderator studies, radiography, and zero-field spin-echo SANS.

Potential application of the dental aesthetic index to prioritize the orthodontic service needs in a publicly funded dental program

Resources for publicly funded dental programs may never be sufficient to accommodate unlimited orthodontic service demands. There is therefore an obligation to ensure that they are preferentially provided to those patients most likely to derive the greatest benefits. To address this strategic concern, the pretreatment records of 38 patients were prioritized on a visual-analog scale relative to their differential orthodontic service needs by 16 independent orthodontic specialists. Unfortunately, inconsistencies in these assessments were unacceptable for a publicly funded program. When these same records were prioritized relative to their scores derived from the Dental Aesthetic Index, their assessments proved more consistent, especially when based on a modified Dental Aesthetic Index. The relevance of such Dental Aesthetic Index scores proved controversial, because the need for orthodontic services is dependent on other factors in addition to esthetics. The lack of established clinical guidelines to delineate the most appropriate service and timing for specific occlusal discrepancies further hampers the prioritization of orthodontic service needs. Dental Aesthetic Index case-scores may therefore be considered as just 1 of many criteria to prioritize orthodontic service needs, although the potential impact of the others has yet to be quantified.

Sulconazole nitrate cream 1 percent for treating tinea cruris and corporis

Sulconazole nitrate 1 percent cream, a new imidazole derivative, was tested in 117 Colombian Army soldiers with tinea cruris/corporis under hot, humid conditions. The results of two clinical trials demonstrate that sulconazole applied once daily was as effective as clotrimazole applied twice daily. After three weeks of therapy 100 percent of the patients treated either once or twice daily with sulconazole showed negative findings on potassium hydroxide preparations and cultures from lesions. Although sulconazole was well tolerated and caused no adverse reactions, four of twenty-seven clotrimazole-treated patients showed reactions consisting of erosive primary irritation. Sulconazole nitrate 1 percent cream appears to be highly effective in the treatment of tinea cruris/corporis when applied once or twice daily and may be very useful in hot and humid conditions where contact irritation reactions occur more often.

A retrospective cephalometric study of Class I patients

In view of the growing consensus that traditional cephalometric analyses yield data of dubious scientific validity, this study was undertaken using an alternative technique, termed finite element analysis (FEA). The study was based on 14 triangular finite elements spanning seven datum (nodal) points delineating cephalometric form. These points were delineated on lateral cephalographs taken immediately before and following the completion of orthodontic treatment for two samples of boys aged 12-16 years. Although both samples exhibited Class I molar occlusions with anterior over-crowding, one sample required bilateral maxillary and mandibular first premolar extraction prior to orthodontic treatment, while the other sample did not. FEA revealed greater cephalometric size and shape changes in the 'non-extraction' than 'extraction' samples. Such sample contrasts, however, varied depending upon the finite element included in the analysis. Further studies are therefore required to delineate the specific finite element configurations to provide precise descriptions of cephalometric change.

An assay of mononuclear cell dynamics in various subcutaneous cranial sites

Although polymorphonuclear leukocyte kinetics at sites of tissue injury have been well documented, analogous mononuclear cell data have yet to be reported because of the lack of suitable assay techniques. In this study, counts of mononuclear cells adherent to nitrocellulose filter discs implanted in four subcutaneous sites for nine consecutive days showed a greater degree of cellular accumulation in the temporalis than in the frontalis region, the data for the masseter and submandibular regions being similar and intermediate. This type of assay may prove useful in elucidating the role of mononuclear cells in wound healing and the effect of antiinflammatory agents on mononuclear cell kinetics.

Effect of internal irrigation on frictional heat generated from bone drilling

Frictional heat generated during bone drilling was reduced by internal irrigation compared with external or no irrigation. This was based on an in vitro study using two bur designs at low rotational speeds to prepare experimental cavities to varying depths.

A new implant philosophy

This form of tooth implant appears to exhibit great potential since it eliminates the disorganized connective tissue layer present at the implant/bone interface of most other devices. Also, as established for other implants, as long as a tight cuff of relatively immovable tissue exists around the polished cervical collar of an implant, an effective seal against the ingress of oral fluid and toxic irritants appears to be maintained, although the nature of this seal has yet to be determined. In addition, the epimobile superstructure serves to dissipate occlusal stress on the "ankylosed" implant. The prognosis of an implant is determined in part by its associated superstructure. There is a need for research into the loading that can be accommodated by an implant. Further study is required to ascertain the full potential of this implant system.