Operative mortality after gastric cancer resection and long-term survival differences across Europe

BACKGROUND

: Little is known at a population level about operative mortality after surgery for gastric cancer and whether differences between countries can explain differences in long-term survival. This study compared operative mortality recorded by ten cancer registries in seven European countries.

METHODS

: Non-conditional logistic regression analysis was performed to estimate the independent effect of the studied factors on mortality within 30 days of surgery. A multivariable survival model was employed with and without operative mortality.

RESULTS

: The overall operative mortality rate in 1611 patients studied was 8.9 (range 5.2-16) per cent. Country of residence was a significant prognostic factor in the multivariable analysis. The likelihood of operative mortality was lower in Italy, France and the UK than in the Netherlands, Spain, Slovenia and Poland. Age, type of gastrectomy and stage at diagnosis were also significant factors. Cancer site was not found to be significant in the multivariable analysis. The overall 5-year relative survival rate varied between 42.0 per cent (Italy) and 24 per cent (Poland); after excluding operative mortality, the 5-year survival rate was 44.3 and 28 per cent respectively.

CONCLUSION

: Within Europe, the substantial differences in operative mortality after gastrectomy only partly explain marked differences in survival after gastric cancer resection.

Development of cortical asymmetry in typically developing children and its disruption in attention-deficit/hyperactivity disorder

CONTEXT

Just as typical development of anatomical asymmetries in the human brain has been linked with normal lateralization of motor and cognitive functions, disruption of asymmetry has been implicated in the pathogenesis of neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD). No study has examined the development of cortical asymmetry using longitudinal neuroanatomical data.

OBJECTIVE

To delineate the development of cortical asymmetry in children with and without ADHD.

DESIGN

Longitudinal study.

SETTING

Government Clinical Research Institute.

PARTICIPANTS

A total of 218 children with ADHD and 358 typically developing children, from whom 1133 neuroanatomical magnetic resonance images were acquired prospectively.

MAIN OUTCOME MEASURES

Cortical thickness was estimated at 40 962 homologous points in the left and right hemispheres, and the trajectory of change in asymmetry was defined using mixed-model regression.

RESULTS

In right-handed typically developing individuals, a mean (SE) increase in the relative thickness of the right orbitofrontal and inferior frontal cortex with age of 0.011 (0.0018) mm per year (t(337) = 6.2, P < .001) was balanced against a relative left-hemispheric increase in the occipital cortical regions of 0.013 (0.0015) mm per year (t(337) = 8.1, P < .001). Age-related change in asymmetry in non-right-handed typically developing individuals was less extensive and was localized to different cortical regions. In ADHD, the posterior component of this evolving asymmetry was intact, but the prefrontal component was lost.

CONCLUSIONS

These findings explain the way that, in typical development, the increased dimensions of the right frontal and left occipital cortical regions emerge in adulthood from the reversed pattern of childhood cortical asymmetries. Loss of the prefrontal component of this evolving asymmetry in ADHD is compatible with disruption of prefrontal function in the disorder and demonstrates the way that disruption of typical processes of asymmetry can inform our understanding of neurodevelopmental disorders.

[Complications of injections of hypoosmotic solutes in an underage patient]

Liposuction represents the standard surgical treatment of localized fat excess. Some non-plastic-surgery-board-certified practitioners are likely to offer non-invasive alternatives treatments. We report the clinical case of a 14-year-old female patient who followed a Lipectomy treatment. The Lipectomy technique consists in a hypodermic injection of hypotonic solutions in order to obtain an adipocytes lysis by osmotic shock. No PubMed referenced scientific publication is related to the efficacy or the tolerance of this technique. Postoperative evolution was marked by a polymicrobial subcutaneous abscess that needed two surgical evacuations and 10 days of overnight stay in our department. Through this clinical case, we evoke the possible dangers linked to the application of a non-evaluated medical technique and the necessity of establishing an official validation agency related to innovative techniques in aesthetic medicine and surgery.

Evaluation of 14 nonlinear deformation algorithms applied to human brain MRI registration

All fields of neuroscience that employ brain imaging need to communicate their results with reference to anatomical regions. In particular, comparative morphometry and group analysis of functional and physiological data require coregistration of brains to establish correspondences across brain structures. It is well established that linear registration of one brain to another is inadequate for aligning brain structures, so numerous algorithms have emerged to nonlinearly register brains to one another. This study is the largest evaluation of nonlinear deformation algorithms applied to brain image registration ever conducted. Fourteen algorithms from laboratories around the world are evaluated using 8 different error measures. More than 45,000 registrations between 80 manually labeled brains were performed by algorithms including: AIR, ANIMAL, ART, Diffeomorphic Demons, FNIRT, IRTK, JRD-fluid, ROMEO, SICLE, SyN, and four different SPM5 algorithms ("SPM2-type" and regular Normalization, Unified Segmentation, and the DARTEL Toolbox). All of these registrations were preceded by linear registration between the same image pairs using FLIRT. One of the most significant findings of this study is that the relative performances of the registration methods under comparison appear to be little affected by the choice of subject population, labeling protocol, and type of overlap measure. This is important because it suggests that the findings are generalizable to new subject populations that are labeled or evaluated using different labeling protocols. Furthermore, we ranked the 14 methods according to three completely independent analyses (permutation tests, one-way ANOVA tests, and indifference-zone ranking) and derived three almost identical top rankings of the methods. ART, SyN, IRTK, and SPM's DARTEL Toolbox gave the best results according to overlap and distance measures, with ART and SyN delivering the most consistently high accuracy across subjects and label sets. Updates will be published on the http://www.mindboggle.info/papers/ website.

Epidemiology and prognosis of synchronous colorectal cancers

BACKGROUND

The aim of this population-based study was to report on the incidence, treatment and prognosis of synchronous colorectal carcinomas.

METHODS

Data were obtained from the population-based cancer registry of Burgundy.

RESULTS

Between 1976 and 2004, 15 562 colorectal cancers were diagnosed. Some 3.8 per cent of patients had synchronous colorectal cancers. The risk of having synchronous cancers was higher in men (odds ratio (OR) 1.41 (95 per cent confidence interval (c.i.) 1.19 to 1.68)), when associated adenomas were present (OR 2.02 (95 per cent c.i. 1.69 to 2.41)), when there were adenomatous remnants on pathological examination (OR 2.10 (95 per cent c.i. 1.73 to 2.55)) and in patients aged over 75 years (OR 1.31 (95 per cent c.i. 1.08 to 1.59)). Synchronous tumours were more often located on the same intestinal segment, although the correlation was weak (kappa = 0.26). Resection for cure was performed in 74.8 per cent of synchronous cancers and 72.0 per cent of single cancers (P = 0.131). Five-year relative survival for synchronous (48.7 per cent) and single (48.3 per cent) cancers was almost identical. Stage, age, associated adenomas and adenomatous remnants were independent prognostic factors.

CONCLUSION

Synchronous colorectal cancers convey a similar prognosis to single tumours. Men and patients aged over 65 years with associated adenomas are more prone to multiple colorectal cancers.

No socioeconomic inequalities in colorectal cancer survival within a randomised clinical trial

There is strong evidence that colorectal cancer survival differs between socioeconomic groups. We analysed data on 2481 patients diagnosed during 1989-1997 and recruited to a randomised controlled clinical trial (AXIS, ISRCTN32414363) of chemotherapy and radiotherapy for colorectal cancer. Crude and relative survival at 1 and 5 years was estimated in five categories of socioeconomic deprivation. Multiple imputation was used to account for missing data on tumour stage. A multivariable fractional polynomial model was fitted to estimate the excess hazard of death in each deprivation category, adjusting for the confounding effects of age, stage, cancer site (colon, rectum) and sex, using generalised linear models. Relative survival in the trial patients was higher than in the general population of England and Wales. The socioeconomic gradient in survival was much smaller than that seen for colorectal cancer patients in the general population, both at 1 year -3.2% (95% CI -7.3 to 1.0%, P=0.14) and at 5 years -1.7% (95% CI -8.3 to 4.9%, P=0.61). Given equal treatment, colorectal cancer survival in England and Wales does not appear to depend on socioeconomic status, suggesting that the socioeconomic gradient in survival in the general population could well be due to health-care system factors.

Survival trends for small intestinal cancer in England and Wales, 1971-1990: national population-based study

This population-based study examines prognostic factors and survival trends among adults (15–99 years) diagnosed with small intestinal cancer in England and Wales during 1971–1990 and followed up to 1995. During this period, the 1- and 5-year age-standardised relative survival rates for small intestinal cancers combined were 42% and 23%, respectively. Duodenal tumours, adenocarcinomas, men, patients with advanced age and the most deprived patients had the poorest prognosis. For all small bowel tumours combined, the excess risk of death fell significantly by 6–9% every 4 years over the 20-year period (adjusted excess hazard ratio (EHR) 0.91 at 1 year after diagnosis, 0.94 at 5 years). For duodenal tumours, the EHR fell by about 14% (95% CI 5–22%) every 4 years between 1979 and 1990, and a similar trend for jejunal tumours was of borderline significance. Further population-based investigations linking survival data to individual data on diagnostic methods and types of treatment are needed.

Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population

BACKGROUND

The aim of this study was to determine the incidence and patterns of failure following potentially curative surgery of colonic cancer.

METHODS

Data were obtained from the cancer registry of the Côte-d'Or (France). Data on 2657 patients who had resection for cure of colonic cancer between 1976 and 2000 were analysed. Local and distant failure rates were calculated using the actuarial method and multivariable analysis was performed using a Cox model.

RESULTS

The 5-year cumulative rate was 12.8 percent for local recurrence and 25.6 percent for distant metastases. Five-year cumulative local recurrence rates were 4.9 percent for stage I, 11.0 percent for stage II and 23.5 percent for stage III tumours (P<0.001). The corresponding rates for distant metastases were 6.4, 21.4 and 48.0 percent (P<0.001). The 5-year cumulative rates for distant metastases were 31.7 percent for the period 1976-1980 and 21.1 percent for 1996-2000, and the local recurrence rates were 17.6 and 9.0 percent respectively. The decreases in rates of local recurrence and distant metastases were significant in multivariable analysis. Cancer extension and presenting features were related to patterns of failure. Tumour location was significantly associated with risk of local recurrence, whereas age and gross features were associated with risk of distant metastasis.

CONCLUSION

Recurrence following resection of colonic cancer remains a substantial problem. Follow-up is of particular importance in the 3 years after surgery.

Trends in the management and survival of digestive tract cancers among patients aged over 80 years

BACKGROUND

Advances have occurred in the management of digestive tract cancers, but it is not known how much they have benefited the elderly.

AIMS

To determine trends in treatment, stage at diagnosis and prognosis of digestive tract cancers among patients aged > or =80 years in two well-defined French populations.

DESIGN

Time trends were studied in three age classes and in 5 four-year time intervals. A multivariate relative survival analysis was performed to estimate the independent effect of both age and period on prognosis.

RESULTS

Five-year relative survival rates were 1.9% for oesophageal cancer, 12% for stomach cancer, 41% for colon cancer and 37% for rectal cancer. The survival rates improved between the first and the fifth period for all cancer sites except for oesophageal cancer. This improvement remained significant after adjustment for age, sex, site and treatment. It was associated with an increase in the proportion of patients who underwent curative resection. Very few patients received adjuvant chemotherapy. The use of adjuvant radiotherapy for rectal and oesophageal cancers did not significantly increase over time.

CONCLUSIONS

Except for oesophageal cancers, substantial advances in the care of digestive tract cancers in the elderly have been achieved. Surgery should not be restricted on the basis of age alone. Further improvements can be made in particular to enhance adjuvant therapy whenever possible.

Is the management of hepatitis C patients appropriate? A population-based study

BACKGROUND

In order for hepatitis C patients to receive antiviral treatment, they must reach medical care.

AIM

To assess the proportion of patients reaching medical care after hepatitis C diagnosis in a general population (1 006 171 inhabitants) in France.

METHODS

Between 1994 and 1999, 1508 cases were diagnosed, of which 1251 were eligible for the study.

RESULTS

Two-hundred and two patients did not have any medical care; among them, 55.4% had normal alanine transferase, 58.4% had risk factors related to lifestyle and 22.8% were alcoholics. Amongst the 1049 other patients, 41.6% had a liver biopsy, 25.0% were treated. Treatment was more often carried out in males than in females (OR: 1.59; P = 0.001), and in patients under 65 than in older patients (OR: 2.22; P < 0.008). Among non-treatment reasons, alcoholism (P = 0.001), drug-addiction (P = 0.04) and escaping monitoring (P = 0.04) were more frequent in males than in females, whereas normal alanine transferase was more frequent in females than in males (P = 0.004). Amongst 278 patients with a Metavir score >A1F1, 71 (25.5%) did not undergo treatment.

CONCLUSION

In a general population, one patient in six did not receive on-going health care; a quarter of patients with a Metavir score >A1F1 did not receive any treatment. These results showed insufficient clinical management, which could compromise the effectiveness of treatment in general population.

Incidence and management of malignant digestive endocrine tumours in a well defined French population

BACKGROUND AND AIMS

Little is known about the epidemiology of malignant digestive endocrine tumours. The aim of this study was to report on their incidence and management in a well defined population.

METHODS

Data were obtained from the population based Digestive Cancer Registry of Burgundy (France) over a 24 year period. Incidence rates were calculated by sex, age groups, and period of diagnosis. Treatment and stage at diagnosis were also investigated. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed.

RESULTS

Between 1976 and 1999, 229 cases were recorded. Age standardised incidence rates were 0.76/100,000 for men and 0.50/100,000 for women. They increased over time in both sexes. The resectability rate was 74.1%. Among recorded cases, 26.6% did not extend beyond the organ, 20% had lymph node metastases, and 53.3% had visceral metastases or were unresectable. There was no improvement in the resection rate or in the stage at diagnosis over the study period. The overall relative survival rate was 66.9% at one year, 50.4% at five years, and 40.6% at 10 years. Stage at diagnosis, age at diagnosis, and subsite were independent significant prognostic factors.

CONCLUSIONS

Although their incidence is increasing, malignant digestive endocrine tumours remain a rare cancer, representing 1% of digestive cancers. Stage at diagnosis and prognosis at a population level are worse than those reported in hospital series. In the short term, new therapeutic possibilities represent the best way to improve their prognosis.

Music decreases sedative requirements during spinal anesthesia

Ambulatory surgery can create significant anxiety. This prospective study measured whether music can influence anxiety and perioperative sedative requirements in outpatients undergoing surgery with spinal anesthesia. We also evaluated the correlation between two anxiety measures, the State-Trait Anxiety Inventory test (STAI) and the 0- to 10-cm visual analog scale (VAS 0-10), with 0 meaning complete relaxation and 10 the worst feeling of anxiety possible. Fifty unpremedicated patients were randomly assigned to listen to music of their choice via headset during the perioperative period (Group I) or to have no music (Group II). All participants used patient-controlled IV midazolam sedation and underwent repeated evaluations of their anxiety level with the STAI and the VAS 0-10. Midazolam requirements during surgery (Group I, 0.6 +/- 0.7 versus Group II, 1.3 +/- 1.1 mg; P < 0.05) and for the whole perioperative period (Group I, 1.2 +/- 1.3 versus Group II, 2.5 +/- 2.0 mg; P < 0.05) were smaller in patients listening to music. Anxiety levels, measured with STAI or VAS 0-10, were similar in both groups. The Spearman's coefficient values between STAI and VAS 0-10 ranged from 0.532 to 0.687. We conclude that patients listening to music require less midazolam to achieve a similar degree of relaxation as controls and that measures of anxiety obtained from the STAI and the VAS 0-10 are positively, but only moderately, correlated.

IMPLICATIONS

It is possible to decrease sedative requirements during surgery under spinal anesthesia by allowing patients to listen to music to reduce their anxiety.

Prevalence of problem gambling among community service users

The prevalence of pathological gambling has been investigated in many countries over the past 10 years. In the United States and Canada, it is estimated that between 1 and 2% of the general population suffer from excessive gambling (Ladouceur, Jacques, Ferland, & Giroux, 1999; Shaffer, Hall, & Vander Bilt, 1997). Some researchers have argued that telephone surveys underestimate the prevalence of this disorder given that many gamblers may be unable to participate in them. Using the South Oaks Gambling Screen, the present study assessed the prevalence of pathological gambling among 87 individuals who rely on community assistance for their survival. The findings indicate that 17.2% meet the criteria for pathological gambling; a prevalence that is approximately 8 times greater than that of the general population. The social implications of these results are discussed.

Profile of handicap situations in children with cerebral palsy

The purposes of this study were to establish a profile of handicap situations in children with cerebral palsy and to identify some variables associated with the occurrence of these situations. Ninety-eight children with a diagnosis of cerebral palsy (mean age +/- 1 SD, 10.5 +/- 3.5 years) were recruited on a voluntary basis. The Life Habits Assessment (LIFE-H, version 1.0) was used to measure the degree of accomplishment in 12 categories of life situations (activities of daily living and social roles). Significant disruptions in the accomplishment of all life habit categories were revealed. The highest disruptions were observed in the following categories: recreation, community, personal care, education, mobility, housing and nutrition. Disruption progressed significantly with increased severity of cerebral palsy. Impairment type, severity, speech and language disorders, and comprehension difficulties explained a high percentage of the total variance (> 60%) in the accomplishment of life habits. The results suggest that life habits related to school and social integration are greatly disturbed.

Association between characteristics of locomotion and accomplishment of life habits in children with cerebral palsy

BACKGROUND AND PURPOSE

"Handicap situation" is defined in the literature as "a disruption in the accomplishment of a person's life habits (activities of daily living and social roles)." The purpose of this study was to determine the strength of association between various types of locomotion and the accomplishment of life habits, which is an indicator of the occurrence of handicap situations in children with cerebral palsy.

SUBJECTS

Ninety-eight children with cerebral palsy, aged 5 to 17.8 years (mean = 10.5, SD = 3.5), were recruited.

METHODS

The Life Habits Assessment was used to evaluate handicap situations in activities of daily living and social roles. Types of locomotion, the Pediatric Functional Independence Measure (locomotion section), and 2 tests representing functional activities (walking speed and stair climbing) were used as characteristics of locomotion.

RESULTS

Locomotion capabilities were associated with the accomplishment of activities of daily living and social roles. Performance in variables related to locomotion, number of associated problems, and type of cerebral palsy explained 17% to 74% of the total variance in accomplishment of life habits in children who walked without technical aids.

CONCLUSION AND DISCUSSION

The results suggest that locomotion might influence the accomplishment of life habits. Other factors, however--such as environmental barriers--should also be examined to determine their impact on the occurrence of handicap situations.

[Determination of virucidal activity. Value of the bacteriophage as a viral model]

Virucidal activity of six disinfectants was determined in vitro against bacteriophages T2, MS2 and phiX 174. The preliminary study shows the simplifications resulting from the use of bacteriophages for this kind of test: easy and reproducible production of stores of bacteriophages with controlled purity, good stability and concentration of at least 10(7) PFU/ml, and no limitation due to cytotoxicity. Virucidal concentrations determined for a 15-minute contact are 31.2 ppm (active chlorine) for hypochlorite solution, 10 ppm (iodine) for an iodophor, 1% for formaline, 0.5% for glutaraldehyde, more than 0.3% for a quaternary ammonium salt and more than 3% for an amphotere. The proposed method gives practical information for decontamination in bio-industry. Given the resistance noted with bacteriophages, this experimental method could be applied in a more general setting.

[Microbiologic study of a new disinfectant: decyloxy-3-hydroxy-2-amino-1-propane hydrochloride]

Decominol exhibits bactericidal activity in a concentration of 0.05% (NF T 72-151). This concentration is increased five-fold in the presence of an albumin-yeast extract mixture, and 2.5-fold in the presence of hard water (60 degrees French). At pH 5.0, 0.5% concentration is not bactericidal (NF T 72-171) Fungicidal activity (T 72-201) is weak at 20 degrees and 50 degrees C and the sporicidal tests (T 72-231) establish the lack of sporicidal activity at 10%. Decyloxy-3 hydroxy-2 in 0.2 amino-1 propane hydrochloride to 1.5% concentrations used in a meat-canning factory ensures satisfactory disinfection of correctly cleansed surfaces. It also proves useful for sterilization of circuits where it can be used as an adjunct to the lethal action of heat.