[Surgery of the low extremity varices as a part of a same-day surgery programme]

INTRODUCTION

One-day surgical methods lower the procedures costs as well the need for urgent beds in surgical clinics. The varix operation seem to be the optimal diagnosis suitable for the one-day surgical procedure.

AIM

The aim of this work is to assess a feasibility of the one-day surgery for the low extremities varix operations.

METHODOLOGY

During the period starting in January until December 2003, 98 extremities were operated for varices. The surgical procedure was the same for the hospitalized as well as for the patients assigned to the one-day surgery programme. Each patient was examined with the duplex ultrasound prior to the surgery, after the surgery a compressive bandage was indicated.

RESULTS

We operated 98 extremities in 96 patients suffering from varices during the period from January 2003 to December 2003. The trial group consisted of 67 females and 29 males aged 21-79 years of age (the average of 45.3 years). According to the CEAP classification, 57 extremities (58.2%) were assigned to the C2 category, 30 extremities (30.6%) to the C3 category, 6 extremities (6%) to the C4 category, 4 extremities (4%) to the C5 category and one extremity (1%) to the C6 category. 14 extremities in the group were operated due to the disease relapse. 62 patients (i.e. 65%) were released for the home-care on the day of the operation, 27 patients (28%) were released the following day. One patient was hospitalized for two days, three patients for three days, one patient for four days and two patients for five days. 91 out of the total 98 extremities (i.e. 93%) underwent the one-day surgery.

CONCLUSION

Although some patients require hospitalization, the varix surgery is safe and suitable for the one-day surgery. A thorough preoperative examination as well each patient's cooperation are both very important.

[Recurrence of varices in lower extremities]

Authors have done a retrospective analysis of 94 lower extremities in 88 patients examined from 1996 to 2002 for recurrence of varices in lower extremities. The goal was to find out the most frequent causes of recurrence of varices in lower extremities in patients with history of varices surgery referred to venous guidance clinic because of another onset of varices in lower extreminites or clinical signs of chronic venous insufficiency. Reflux was proved in 78 lower extremities from the total number of 94 (83%) in our sample. Isolated reflux was discovered in 59 extremities in saphenofemoral junction (39 extremities), in saphenopopliteal junction (14 extreminies), and in perforators (6 extremities). Combined reflux detected simultaneously in two or three places (SFJ, SPJ, perforators) was found in 19 extremities. In 11 cases the reflux was proved in two places and in 8 cases even in 3 places simultaneously. The main cause of recurrence of varices in lower extremities in our sample was reflux especially in saphenofemoral junction and saphenopopliteal junction. Reflux in perforators was usually accompanied with saphenofemoral and/or saphenopopliteal junctions incompetence. Isolated reflux in perforators was found very rarely (6.4%). The cause of varices recurrence was not disclosed in 17% of cases.

[Total stripping of the greater saphenous vein--an obsolete method?]

The authors discuss the surgical treatment of primary varices. The analysis is based on pathophysiological principles in the development of venous insufficiency. The attention is paid to reflux in key positions, presumably sapheno-femoral and sapheno-popliteal junctions, respectively. Dilated perforators with a reflux are considered to ensue from these refluxes. These principles enable to draw conclusions on an adequate therapeutic procedure, a limited stripping of saphena veins. A total stripping is indicated only exceptionally, when the whole stem is affected.

[Chronic venous insufficiency--outpatient study of risk factors]

The aim of the clinical study was to monitor and analyse possible causes of chronic venous insufficiency (CVI) in a randomised sample of patients with diagnosed CVI. There were 100 patients in the investigated sample, 82 women of an average age of 40.4 years and 18 men of an average age of 42.7 years. Monitoring of risk factors of development and advancement of CVI in our sample of patients showed following results: 1. frequent overweight and obesity (BMI > 25 kg/m2) in women (47.6%) and men (83%) with relatively frequent cases when a patient put on weight more than 5 kg within the last 5 years before development of CVI signs (24.4% of women and 22% of men); 2. a predominance of multiparas (68.3%) over women who have not given a birth or gave birth to 1 child (31.7%), we have found a big percentage of multiparas among both women younger than 40 (40%) and especially older women (> or = 40 years) where the percentage was 75.4%); 3. a positive family history in the majority of our patients with CVI (71%), in 88.7% in a first grade relative; 4. the major part of people in the sample were standing when working (59%), the number of people with sedentary work was high too (32%); 5. smoking admitted only minor part of the CVI patients (27%); 6. significant history of hormonal treatment in the female patients (37.8%), especially among women younger than 40 (48%); 7. other risk factors (accidents and surgeries of lower extremities, recurrent thrombophlebitis) appeared either in a very small percentage of the patients (lower limbs surgeries) or in significantly smaller percentage compared to risks in points 1 to 4 (accidents of lower extremities 20%), recurrent thrombophlebitis 22%).

Esophageal dysfunction in a female patient with diabetes mellitus and achalasia

BACKGROUND

Achalasia is an infrequent disorder of esophageal motility. Diabetes mellitus is an endocrine metabolic disease, the complication of which can afflict the motor activity of gastroenteral tract. The combination of these diseases in one patient is also very rare. In this study we introduce one patient suffering from this scarce coincidence of diseases.

CASE HISTORY

A 54-year-old diabetic patient who lost weight of 26 kg in one month with repeated hypoglycaemic collapse states and regurgitation of poorly digested food and saliva with maintained appetite and thirst. The diagnosis of esophageal achalasia II was proved. A standard surgical performance was chosen, namely the laparoscopic myotomy. The extent of myotomy was verified by preoperative manometry. Approximately 1 month after the surgery, intermittent mild dysphagia especially after the consumption of solid food and some sorts of fruit appeared. The suspicion of stricture in the site of myotomy led us to the performance of endoscopic and radiologic examinations. The balloon calibration of cardia did not reveal any residual muscular fibres. The supplementation of a prokinetic drug of itoprid three times a day resulted in a significant improvement of difficulties.

CONCLUSION

Despite the sufficient extent of surgical treatment in a patient suffering from these two diseases, the resulting effect was not fully satisfactory. It is apparent that despite the correctly indicated and performed operation in patients suffering from a metabolic disease, the complications of which afflict the motility of upper digestive tract, the ideal response to treatment cannot be expected. The supplemented prokinetic therapy is inevitable, and informing the patient on the expected result and particular residual disorders can save both the patient and surgeon from disappointment. (Fig. 3, Ref. 8.).

[CHS 100P surgical mesh in inguinal hernioplasty in adults using the Lichtenstein tension-free method]

AIMS

The authors present their initial experience with surgical grid CHS 100 P with strengthened middle strip for the intestinal hernioplasty by the method without tension according to Lichtenstein.

METHODS

In the inguinal hernioplasty by anterior transinguinal way in adult patients the authors use prolene grid and a surgical grid CHS 100 P with strengthened middle strip having been developed in collaboration with the Research Knitting Institute in Brno.

RESULTS

From November 2001 to May 2003 56 adult patients were operated on inguinal hernia by the tensionless plasty according to Lichtenstein using a surgical grid CHS 100 P. No preoperation of postoperation complication or relapse were encountered. The patients were subject to load in the first postoperation day.

CONCLUSION

Based on our first experience with flexible surgical grid with strengthened middle band CHS 100 P used for tensionless inguinal hernioplasty in adult patients according to Lichtenstein it may be concluded that the grid is well tolerated by the patients. Flexibility of the grid makes it possible to fully load inguinal area during the first postoperation day.

[Complications after laparoscopic surgery of inguinal hernias]

AIMS

The authors describe the occurrence of complications in laparoscopic approach to treat inguinal hernias in patients operated on at 2nd Surgical Clinic in Olomouc from May 1991 to the end of the year 2002.

METHODS

The occurrence of preoperation and postoperation complications and relapses in inguinal hernias treated with laparoscopy in the period of May 1991 to the end of 2002. The TAPP method was used for operation on 98% of inguinal hernias, the IPOM method for 0.9% of inguinal hernias, TEP method in 0.4% and a simple suture in operation on 0.7% of inguinal hernias.

RESULTS

Five hundred and thirty four (56% of all surgically treated inguinal hernias) were treated with laparoscopy in adult patients in the period of May 1991 to the end of 2002. Eight preoperation and postoperation complications (1.4%) were encountered. These included two cases of hematoma in the wound after port (0.3%), one hematoma of scrotum (0.2%), two artificial perforations of intestine (0.3%), one case of neuralgia of n. genitofemoralis, one artificial perforation of urinary bladder (0.2%), and one postoperation hydrocele (0.2%). There were 14 relapses (2.6%) in the 534 inguinal hernias operated on with laparoscopy.

CONCLUSION

Based on our experience in the solution of inguinal hernias with laparoscopy the method of transabdominally-preperitoneally localized grid (TAPP). In this method we have used three-point fixation--by a screw to pected ossis pubis and the upper margins of the grip with two transparietal stitches fixed permanently in subcutaneous tissue.

[Peroperative diagnostic methods during esophageal achalasia surgery. Initial experience]

AIM OF THE STUDY

The authors present their first experience with the application of esophageal manometry during the operation on achalasia of esophagus. The completeness of performed myotomy is evaluated on the basis of decreased pressure in the region of lower esophageal sphincter (LES).

METHODS

Stationary pull-through four-channel manometry was performed twice during the operation: before the application of capnoperitoneum to localize LES with evaluation of its length and tonus and after the myotomy was performed after capnoperitoneum was abolished to verify sufficient extent of myotomy. The subsequent endoscopic control was used to exclude damage of esophagus mucous membrane.

RESULTS

In the period of one year during 2002/2003 the authors operated on four patients with achalasia, when manometry was used for peroperative localization of LES and evaluation of the extent of myotomy. The peroperation manometry demonstrated decreased tonus of LES (the mean 42.06 mmHg before myotomia and the mean 20.03 mmHg after myotomia) and in one case the finding resulted in necessary extension of myotomia.

CONCLUSIONS

Based on our preliminary experience with peroperation manometry in operations on achalasia of esophagus it may be stated that it is a useful method for objectivization of the completeness of myotomy, which does not significantly prolong the period of operation. It contrast, it makes it possible to respond to lasting hypertonic area in LES subjected to myotomy, which may be the cause of lasting complaints of patients after the operation.

Open versus laparoscopic appendectomy

BACKGROUND/AIMS

To asses the role of laparoscopic appendectomy in the treatment of acute as well as chronic appendicitis on the basis of our own experiences.

METHODOLOGY

From the set of 849 patients treated with appendectomy (from January 1993 to December 2000) 331 were singled out, i.e.; those unable to work for some time and thus being on sickness benefit who asked for a medical certificate. They were operated on for either acute or chronic appendicitis.

RESULTS

In our set of 331 patients (158 males, 173 females, the average age 29.4) open appendectomy was performed on 179 patients and laparoscopic appendectomy on 152. Laparoscopic appendectomy was performed in 43 males (28%) and 109 females (72%); open appendectomy in 115 males (64%) and 64 females (36%). Laparoscopic appendectomy took 53.7 +/- 18.1 minutes, open appendectomy took 43.6 +/- 8.99 minutes. The time of work disablement is longer in open appendectomy (open appendectomy: 41.2 +/- 9.91 days; laparoscopic appendectomy; 29.1 +/- 15.11 days). A significant difference (p < 0.00001) can be seen in the length of hospitalization (laparoscopic appendectomy: 5.0 +/- 2.75 days, open appendectomy: 8.3 +/- 2.83 days).

CONCLUSIONS

Patients who undergo laparoscopic appendectomy spent less time in hospital, and they can return to work rather earlier. On the other hand the time of surgery is longer. Higher cost is compensated for with shorter hospitalization and early return to work.

[Anatomic and hemodynamic changes in the venous vascular bed in the lower extremities with chronic venous insufficiency]

The authors paid attention to revealing as precisely as possible anatomical and haemodynamic conditions in venous vascular bed in the course of ultrasonographic examination of 309 lower extremities with clinical manifestations of chronic venous insufficiency (CVI). A combined reflux in the superficial and deep venous system (53.7%) or isolated reflux in superficial veins (25.9%) proved to be the most frequent pathogenic bases of CVI. Pathophysiology of varices was mostly based on the venous reflux and the primary idiopathic CVI was mostly present (98.1%). The post-thrombotic partial obstruction of the deep venous system (post-thrombotic venous changes on the walls) was demonstrated exceptionally (1.9%). A high coincidence of reflux in the deep and superficial venous system points out to s.c. secondary reflux in the deep veins originating on the basis of primary reflux in the large or small saphena. An attempt was made to clarify, whether the development and frequency of incompetent perforators is directly connected with the presence and seriousness of reflux in the large and small saphena. The presence and severity of large saphena insufficiency does not univocally indicate the presence of dilated or insufficient perforators on the medical side of the crus, where these anastomoses are present most frequently. The large saphena is a long vein typically suffering from segmental insufficiency, i.e. reflux affecting a certain portion, whereas other parts of the vein may be fully competent. Anatomical venous variability and abnormalities on lower extremities were demonstrated in every fifth extremity (62 extremities, 20.1%). Most of them concerned large saphena (39 extremities, 62.8%), small saphena being second (15 extremities, 25.2%). Other anatomical deviations occurred sporadically as solitary findings. In the large saphena, duplication was present most frequently (54.8%). Insufficient variable superficial veins and anatomical venous anomalies were mostly not the only pathogenic basis of CVI, but were predominantly associated with insufficiently in the area of deep veins and perforators (84%). In our cohort there were altogether 55 extremities (17.8%) after the operation on superficial venous system, where relapses of varices were found. The causes of post-operation relapse of varices may be divided into three groups: 1. insufficiency of the large saphena, 2. insufficiency of the small saphena and 3. insufficiency of the deep veins. A combined simultaneous insufficiency in several venous systems was found most frequently (27 extremities, 49.1%). Even though the reflux in the deep veins was demonstrated in 50.9% of these extremities, a combination with the reflux in superficial veins and perforators (49.1%) was present with the exception of one case of isolated insufficiency. The insufficiency of the large and small saphena was clearly the leading single causes (15 extremities, 27.3%) of varix relapses. The patients should never be operated on the venous system of lower extremities without previous detailed ultrasonographic examination. It is the only way to increase probability of the operation success and to decrease the risk of relapses of CVI manifestations.

Limited versus total stripping of vena saphena magna

BACKGROUND

There are two different ways to operate on patients with varicose veins.

OBJECTIVES

Prospective evaluation of two groups of patients operated on in two different ways to find out more convenient procedure for varicose veins surgery.

METHODS

The results of 577 patients operated on for lower limbs varicose veins were evaluated. The patients were divided into two groups. The first group comprised of 125 patients in whom limited stripping of vena saphena magna was performed. The second group comprised of 397 patients in whom total stripping of vena saphena magna was applied. In the remaining 55 patients an operation other than VSM was performed in the venous system of lower limbs. During the follow-up three months after the operation the main attention was paid to a possible neurological disturbance.

RESULTS

Much better results were observed in the group of patients treated with the method of limited stripping. Neurological disturbances occurred in two patients only (i.e. 1.6%). Within the other group disturbances were encountered in 28 patients (i.e. 7%).

CONCLUSIONS

Limited stripping of vena saphena magna results in lower number of neurological disturbances. (Tab. 1, Ref. 10.).

[Severing perforators in advanced stages of chronic venous insufficiency]

OBJECTIVE

To evaluate the importance of anastomozing veins in the development of chronic venous insufficiency (CVI).

METHOD

Perspective analysis of a group of 82 extremities where the perforators were severed by the endoscopic or open method.

RESULTS

Surgery of the perforators was associated with a decline of the total number of perforators detectable on DUS, with a marked reduction of extremities with insufficient perforators and improved total CEAP score. In 98% extremities at the same time surgery of the epifascial venous system was performed.

CONCLUSIONS

The role of perforators in the development of CVI is not unequivocal and its assessment is more difficult due to concurrent operations of the epifascial system. Dissection of the perforators is indicated in cca one tenth of patients with CVI.

[Endoscopic subfascial dissection of perforators (ESDP) vs open ligation of perforators]

OBJECTIVE

Comparison of two surgical procedures in discontinuation of the venae perforantes.

METHOD

The authors evaluated perspectively a group of 78 patients subjected to 82 operations with severing of the venae perforantes on the lower extremities. They defined the indications for both surgical procedures.

RESULTS

The open procedure (Cockett's segmental operation) was indicated in 10 extremities, ESDP in 72. The endoscopic operation lasted on average 59 minutes, the open one 50 minutes. The hospitalization period in the endoscopic variant was shorter (6.1 days vs. 8.5 days after the open operation). preoperative complications such as haemorrhage from the severed perforator occurred in ESDP. In Cockett's operation there were no preoperative complications, but there were two cases of healing per secundam during the postoperative period. Healing of crural ulcers within 12 weeks was recorded in both types of operations. The open procedure is indicated where there are major nodes on the leg and there are no extensive trophic changes, in particular in patients in stages C3 and C4. ESDP is indicated in patients in advanced stages of CVI, i.e. C5 and C6 according to CEAP.

CONCLUSIONS

Every method has its indications whereby a higher incidence of complications may be foreseen after the open operation as compared with the endoscopic one.

Consensus statements from the Second International Lung Cancer Molecular Biomarkers Workshop: a European strategy for developing lung cancer molecular diagnostics in high risk populations

The Second Molecular Biomarkers Workshop was held at the Roy Castle International Centre for Lung Cancer Research in Liverpool, in June 2001 and it brought together experts in the clinical, epidemiological and molecular-pathology of lung cancer from Europe and the USA, to address issues surrounding the development of a European strategy for early lung cancer detection. The 2001 Workshop Breakout Groups concentrated on the current challenges in the early detection of lung cancer which need to be addressed in the light of the recent surge in interest in many countries for mounting new clinical trials to evaluate the utility of Spiral CT in early lung cancer detection. If population-based trials of CT screening are mounted it will also be a favorable clinical environment in which to evaluate efficiently recent advances in molecular screening and genotyping. The Workshop focused specifically on: a) clinical and molecular biomarkers, b) sputum as an early detection and diagnostic tool, c) validation of molecular markers prior to their use in early detection trials and d) ethical issues that have to be considered in early lung cancer detection trials. A distillation of the Workshop discussions is given in this article.

Primary malignant melanoma of the esophagus treated by endoscopic ablation and interferon therapy

Primary malignant melanoma of the esophagus is a rare illness accounting for 0.1-0.2% of malignant diseases of the esophagus; however, the incidence of the disease appears to be rising. The average survival time is between 10 and 15 months. The authors describe the 25 month follow up of a patient with primary malignant melanoma of the esophagus which was treated with endoscopic ablation followed by interferon therapy. No other focus was found and the patient is undergoing regular endoscopic check-ups, currently without any problems.

[Manometry in esophageal achalasia]

OBJECTIVE

Manometric findings in achalasia are pathognomic already in early clinical stages of the disease. The authors evaluate the importance of manometry in the diagnosis and therapy, in particular in early stages of the disease.

METHOD

During manometry we obtain data on the function of the lower oesophageal sphincter and the body of the oesophagus. Impaired relaxation of the sphincter is evaluated, as well as increased tonus of the sphincter and tertiary contraction of the body of the oesophagus. In patients with achalasia we implement laparoscopically extramucous myotomy.

RESULTS

In 1997 we started a prospective manometric study of dysphagic complaints. We examined 304 patients on account of different diseases of the oesophagus incl. 16(5.2%) where we proved or confirmed achalasia in stage I, II or III according to the radiological classification. These patients were indicated for laparoscopic myotomy. In one instance we had to convert the operation to an open one. In two instances we added partial fundoplasty according to Thal on account of perforation of the oesophageal mucosa. Four patients were subjected after a 5-12-month interval to remyotomy. Twice because of the development of a fibrous stricture at the site of myotomy and twice for an obviously inadequate original myotomy. The history of dysphagia in patients with primary operations was on average 37.3 months.

CONCLUSIONS

Manometric examination of patients with functional dysphagia makes it possible to detect achalasia in early stages and to indicate in time surgical treatment. In case of a relapse or persistence of complaints manometry makes it possible to express objectively the cause which is most frequently an atonic oesophagus with inadequate evacuating capacity, stricture at the site of myotomy or inadequate myotomy.

The association between funding by commercial interests and study outcome in randomized controlled drug trials

BACKGROUND

Previous studies limited to specific drugs or journal types have shown an association between the source of funding of research and the published results.

OBJECTIVE

The aim of the present study was to determine the association between source of support of research and published outcomes of randomized controlled drug trials in general interest medical journals.

METHODS

Randomized controlled drug trials (n = 314) published in five general interest medical journals over a 2-year period were reviewed. Study outcome was classified as positive or negative. Support was classified as pharmaceutical industry or non-industry. Association between source of support and outcome was tested with the chi-squared statistic.

RESULTS

Positive findings were found in 77% of studies, negative findings in 20% and an uncertain outcome in 3%. Support from commercial sources was found in 68% of trials. Negative findings were found in 13% of industry-supported studies and in 35% of non-industry-supported studies (chi-squared = 18.36, P < 0.0001, odds ratio = 3.54, 95% confidence interval 1.90-6.62).

CONCLUSIONS

An association was found between the source of study support and the published outcome. Though the reason for this association cannot be determined from the data collected, future studies may clarify the importance of this finding for readers concerned with the relationship of funding bodies to the publication of research outcomes.

Recent advances and future prospects in intestinal and multi-visceral transplantation

From an experimental procedure, intestinal transplantation (ITx) has evolved over the last 10 yr into a treatment option for patients suffering from short bowel syndrome and who develop life-threatening complications from total parenteral nutrition (TPN) (e.g. liver dysfunction, line sepsis, shortage of venous access, etc.). One-year survival rates are approximately 70% and thus similar to lung Tx. However, the intestine remains the most challenging abdominal organ to transplant. This is because of the severe immune response (mostly rejection) that is produced, and therefore the need for profound immunosuppression with its attendant complications (sepsis, lymphoma, direct drug toxicity). Unlike other organs, graft loss as a result of acute rejection can occur late after transplantation (more than 1 yr post-transplant). With regard to the actual immunosuppressive regimens, considerable experience in patient management is required to optimize outcome of those complex transplants, which are permanently at risk of rejection and infection. ITx remains an unfinished product, and the application of ITx to patients doing well on TPN warrants further research in the understanding of the rejection process, in the development of less toxic and more efficient immunosuppressive protocols, and in the development of immunomodulatory strategies, to better control rejection and thereby reduce the need for immunosuppression.

Dysplasia of tubular cells in a kidney- transplanted patient treated with recombinant human growth hormone

After renal transplantation (Tx), children with growth retardation can be successfully treated with recombinant human growth hormone (rhGH). However, the impact of this treatment on kidney allograft function remains a source of concern. We report on one boy who received a cadaveric kidney transplant at 12 yr of age, after developing end-stage focal and segmental glomerulosclerosis and hyalinosis. The early post-transplant period was complicated by thrombosis of an arterial branch of the graft and two acute rejection episodes. Because of poor growth, the boy was treated with rhGH starting 22 months after the Tx. The renal function remained relatively stable for 22 months after initiation of rhGH therapy and then progressively deteriorated over a period of 10 months, with the patient ending up on dialysis. Several biopsies, performed for rejection episodes or before the start of rhGH, or to elucidate the deterioration of the renal function, were analyzed. Histologically, a progressive increase in the amount of hypertrophy of the tubules and of the glomeruli was seen after initiation of rhGH. Hyperplasia of the tubular epithelium with crowding of cells of the proximal tubules, hyperchromasia and irregularities in the shape of the nuclei, and abrupt changes of chromatism along the tubuli, were also observed. These lesions of tubular dysplasia are extremely unusual in transplanted kidneys and are unlikely to be caused by compensatory hypertrophy secondary to destruction of renal tissue. They may be an effect of rhGH treatment. The prognostic significance of these lesions is unknown but merits attention.

Pediatric renal transplantation: a single Belgian center experience over 20 years

Between 1980 and 2000, 100 renal transplantations were performed in 91 children at the pediatric unit of the University Hospital Leuven. The proportion of living-related donors (LRD) was 20%. Patient survival rates were 94% at 3 yr, 91% at 5 yr, and 87% at 10 yr. The commonest causes of death were bacterial infections and cardiovascular complications, which underscores the need for aggressive preventative procedures in this area after transplantation. The overall actuarial graft survival was 82% at 3 yr (n = 73), 74% at 5 yr (n = 53), and 56% at 10 yr (n = 29). In the LRD group, the graft survival was 10% better than the overall actuarial graft survival rate. The overall incidence of acute rejection was 55% but has shown a decrease to 34% in more recent years (1993-99). The major causes of graft failure were chronic rejection and recurrence of the initial disease, and these remain a major concern. Improvement of these results could be achieved by tight immunosuppression management, early aggressive treatment of infection and rejection, and careful educational and psychological support.

Comparison of fluorescein break-up time measurement reproducibility using standard fluorescein strips versus the Dry Eye Test (DET) method

PURPOSE

To compare the repeatability of fluorescein break-up time (FBUT) measurements determined with either a standard fluorescein strip or the Dry Eye Test (DET) modified fluorescein strip methods.

METHODS

This was a prospective, randomized contralateral study of 100 patients, in which FBUT measurements were determined with a standard FUL-GLO fluorescein strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) in one eye and a DET strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) for the contralateral eye. Three consecutive measurements were made immediately after fluorescein instillation. The second eye was evaluated 1 minute after completion of the first eye. Data from patients with FBUT values less than 20 seconds were included in the data analysis, because measurements greater than 20 seconds are not diagnostically significant.

RESULTS

Seventy-five patients met enrollment and FBUT measurement criteria. For three consecutive FBUT measurements, the DET values were within 3 seconds for 72 of the 75 patients (96%). Eighty percent of patients reported no sensation with the DET strip, 20% reported mild sensation, and no patient reported moderate sensation. With FUL-GLO strips, measurements were within 3 seconds for 53 of the 75 patients (71%) (p <0.005). The standard fluorescein strip method elicited reports of no sensation from 31% of patients, mild sensation from 60%, and moderate sensation from 9% (p <0.001).

CONCLUSIONS

The DET strip provides a significant reduction in sensation upon application, improved single measurement reliability, and enhanced measurement precision, compared with a conventional fluorescein strip.

Cues to participation in prostate cancer screening: a theory for practice

PURPOSE/OBJECTIVES

To develop and test the Cues to Participation in Prostate Cancer Screening Theory, which proposes that exposure to information from certain sources cues or triggers screening.

DESIGN

Descriptive correlational.

SETTING

11 counties of a southeastern state.

SAMPLE

Convenience sample of 1,867 men at risk for prostate cancer (72% African American; 28% Caucasian).

METHODS

Recent exposure to prostate cancer information was measured. Men were offered free screening by prostate specific antigen (PSA) and digital rectal exam (DRE).

MAIN RESEARCH VARIABLES

Demographic variables (race, age, education, income, and marital status), exposure (electronic media, print media, healthcare provider recommendation, and interpersonal interactions), and screening as measured by PSA and DRE.

FINDINGS

Several major propositions of the Cues to Participation Theory were supported. General exposure to prostate cancer information significantly predicted screening participation. Hearing about prostate cancer from a healthcare provider was the best predictor of screening.

CONCLUSIONS

Men's demographic characteristics should be considered when providing information about prostate cancer. Hearing about prostate cancer from family and friends was not significantly related to screening behavior.

IMPLICATIONS FOR NURSING PRACTICE

The importance of recommendations for prostate cancer screening is underscored.