Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery

BACKGROUND

Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with 'conventional' surgery, but there is a potential for higher morbidity.

METHODS

Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study).

RESULTS

Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing 'conventional' resection at the other three hospitals. Laparoscopic CME was performed in 258 (48·8 per cent) and laparoscopic 'conventional' resection in 1172 (68·9 per cent). More extended right colectomy procedures were done in the CME group (17·4 versus 3·6 per cent). The 90-day mortality rate in the CME group was 6·2 per cent versus 4·9 per cent in the 'conventional' group (P = 0·219), with a propensity score-adjusted logistic regression odds ratio (OR) of 1·22 (95 per cent c.i. 0·79 to 1·87). Laparoscopic surgery was associated with a lower risk of mortality at 90 days (OR 0·63, 0·42 to 0·95). Intraoperative injury to other organs was more common in CME operations (9·1 per cent versus 3·6 per cent for 'conventional' resection; P < 0·001), including more splenic (3·2 versus 1·2 per cent; P = 0·004) and superior mesenteric vein (1·7 versus 0·2 per cent; P < 0·001) injuries. Rates of sepsis with vasopressor requirement (6·6 versus 3·2 per cent; P = 0·001) and postoperative respiratory failure (8·1 versus 3·4 per cent; P < 0·001) were higher in the CME group.

CONCLUSION

CME is associated with more intraoperative organ injuries and severe non-surgical complications than 'conventional' resection for colonic cancer.

Patterns and trends of sexual behavior, HIV testing, and HIV prevalence among all sexually transmitted disease clinic attenders in Denmark

BACKGROUND AND OBJECTIVES

Persons attending a sexually transmitted disease (STD) clinic have shown to be at a higher risk for HIV infection than the population in general. We evaluate the patterns of HIV prevalence and testing in relation to reported risk behavior.

STUDY DESIGN

Data have been collected on all new attenders at the Danish STD clinics. The study period was January 1, 1990 through March 1992.

RESULTS

Testing for HIV was accepted by 74% and more often by women than men and more outside Copenhagen than in the city itself. Acceptance was lowest among homo/bisexual men seen in Copenhagen. The HIV prevalence was highest among homo/bisexual men with drug use (10.0%) and lowest among heterosexual men (0.3%) and women (0.2%). Among heterosexuals the test activity increased over time, and the test activity increased and the prevalence of HIV antibodies decreased with the number of reported sex partners. Among heterosexuals HIV infection was associated with not being born in Denmark and age (> or = 30 years old in women and > or = 35 years old in men).

CONCLUSION

These results are relevant for the national HIV surveillance programs and campaigns, and stress the importance of offering HIV testing to all persons attending for an STD examination.

The 'absent' appendix

During an operation for suspected appendicitis, the surgeon concluded that the appendix was absent. The causes of this situation are presented and a guide to its management is suggested.

Fat and gastric acid secretion

To evaluate the importance of the terminal carboxyl group of the oleic acid molecule in the inhibition of gastric acid secretion, 6 normal persons were stimulated twice with duodenal perfusates containing either 20 mM oleic acid or 20 mM oleyl alcohol. Oleic acid significantly inhibited the gastric acid secretion stimulated by pentagastrin (100 ng/kg/h) and increased the levels of secretin in plasma. The effect of oleyl alcohol was insignificant. It is concluded that the carboxyl group of the fat molecule has an important role in the inhibition of gastric acid secretion, and the effect could in part be attributable to the release of secretin into plasma.

Reduced neutrophil LTB4 release in atopic dermatitis patients despite normal fatty acid composition

Propositions about an abnormal fatty acid metabolism in atopic dermatitis patients prompted us to compare the phospholipid fatty acid composition and LTB4 release of neutrophils from 15 atopic dermatitis patients, as well as the adipose tissue triglyceride fatty acid composition, to that of 15 healthy controls matched by age, gender, and smoking habits. We found no differences in the tissue fatty acid composition between the two groups. The release of leukotriene B4 from Ca-ionophore-stimulated neutrophils in patients was on the average only 42% (p less than 0.001) of that measured in the control group, despite the very similar arachidonic acid contents of these cells. Our study does not support the assumption of an abnormal fatty acid desaturation in atopic dermatitis patients. Rather, the capacity to release and/or convert arachidonic acid into leukotrienes in neutrophils appears to be affected by this disease.

Nickel-sensitive patients with vesicular hand eczema: oral challenge with a diet naturally high in nickel

Oral challenge with nickel sulphate indicated that vesicular hand eczema in nickel-sensitive patients may be exacerbated by nickel occurring naturally in the diet. Twelve nickel-sensitive females with vesicular hand eczema were challenged with a supplementary high nickel diet for 4 days in a single-blind cross-over study. The diet had about five times the average nickel content of the daily Danish diet. An aggravation of the hand eczema was observed in six out of 12 patients on day 4 after the start of the challenge. By day II, the hand eczema was worse in 10 out of 12 patients, and remained unchanged in two.

Penicillamine-induced bullous pemphigoid with pemphigus-like antibodies

A rheumatoid arthritis case is described who developed bullous skin eruption with mucosal involvement after 3 years of treatment with penicillamine. Histologically, changes compatible with bullous pemphigoid were found. Direct immunofluorescence showed linear, as well as intercellular, deposits of IgG. By indirect immunofluorescence IgG antibodies reacting with the basal membrane zone, as well as the intercellular substance, were detected in the serum. We believe that the patient had bullous pemphigoid with pemphigus-like antibodies induced by penicillamine.

Determination of zinc in erythrocytes, granulocytes and serum by flame atomic absorption spectrophotometry

Zinc was determined in granulocytes, erythrocytes and serum by flame atomic absorption spectrophotometry. Using a Teflon sampling cup, the sample volume for a single granulocyte zinc determination was reduced to 100 microliter. Zinc in serum and erythrocytes was measured by aspirating the sample at a rate of 5 ml/min. The total volume of blood used was 23-28 ml. The intra-assay coefficient of variation of the method for granulocytes was 0.01 and of the method for serum and erythrocytes 0.018. The corresponding inter-assay coefficient of variation was 0.037 and 0.03, respectively. Recovery of zinc determined by the method of aspirating the small volume (100 microliter) was 103% and by the method of aspirating 5 ml/min 97%. The coefficient of correlation between the two methods was r = 0.9968.

Changes in zinc and zinc-dependent enzymes in rheumatoid patients during penicillamine treatment

Zinc in granulocytes, erythrocytes, serum, urine and zinc-dependent enzymes (alkaline phosphatase in serum and granulocytes, carbonic anhydrase in erythrocytes) were measured in patients with rheumatoid arthritis before and during penicillamine therapy for 6 months. The zinc concentration in serum, urine and erythrocytes increased, while granulocyte zinc decreased. Alkaline phosphatase activity in plasma remained unchanged, while alkaline phosphatase in granulocytes decreased. Carbonic anhydrase activity in erythrocytes decreased. None of the changes could be related to the activity of the disease.

A rapid one-step method for the isolation of human granulocytes from whole blood

A rapid one-step method for the separation of granulocytes, mononuclear cells and erythrocytes from peripheral blood using two different gradients of Percoll (density solution I: 1.075 kg/l; solution II: 1.096-1.098 kg/l) is described. The influence of temperature on the density of solution II was tested and the variations were found to be of some importance. The average yield of granulocytes from 14 donors was 87.6 +/- 9.6%, and the purity of the granulocytes was 99.66 +/- 0.33%.