Long-term trajectories of densely reported depressive symptoms during an extended period of the COVID-19 pandemic in Switzerland: Social worries matter

Previous mental health trajectory studies were mostly limited to the months before access to vaccination. They are not informing on whether public mental health has adapted to the pandemic. The aim of this analysis was to 1) investigate trajectories of monthly reported depressive symptoms from July 2020 to December 2021 in Switzerland, 2) compare average growth trajectories across regions with different stringency phases, and 3) explore the relative impact of self-reported worries related to health, economic and social domains as well as socio-economic indicators on growth trajectories. As part of the population-based Corona Immunitas program of regional, but harmonized, adult cohorts studying the pandemic course and impact, participants repeatedly reported online to the DASS-21 instrument on depressive symptomatology. Trajectories of depressive symptoms were estimated using a latent growth model, specified as a generalised linear mixed model. The time effect was modelled parametrically through a polynomial allowing to estimate trajectories for participants' missing time points. In all regions level and shape of the trajectories mirrored those of the KOF Stringency-Plus Index, which quantifies regional Covid-19 policy stringency. The higher level of average depression in trajectories of those expressing specific worries was most noticeable for the social domain. Younger age, female gender, and low household income went along with higher mean depression score trajectories throughout follow-up. Interventions to promote long-term resilience are an important part of pandemic preparedness, given the observed lack of an adaptation in mental health response to the pandemic even after the availability of vaccines in this high-income context.

Contents, Methods, and Outcomes of Adolescent Sexual Health Promotion in School Environments: A Scoping Review. J Sch Health 2024;94:184-199. [PMID: 37723616 DOI: 10.1111/josh.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

Schools play a significant role in adolescent sexual health (SH) promotion. Although adolescents' SH has improved, growing challenges still exist in some areas. Previous studies have noted a lack of knowledge about SH promotion implementation in school environments. The purpose of this review is to describe the contents, methods, and outcomes of adolescent SH promotion in school environments.

METHODS

Three databases (Cinahl, ERIC, Medline) were searched for peer-reviewed articles published in 2011 to 2022, to identify SH promotion in school environments for adolescents aged 12 to 19 years old. After critical appraisal, inductive content analysis was conducted.

RESULTS

After screening, 25 studies from 8 countries were included. Sexually transmitted diseases and contraception were emphasized in the contents of the methods. Five SH promotion methods were identified: traditional, virtual, interactive, practical skills supporting, and creative. The outcomes were advancement in SH abilities, changes in sexual behavior, and the strengthening of sexual identity.

CONCLUSIONS

The contents mostly considered negative consequences of sexual behavior, whereas positive aspects were less discussed. Traditional methods were emphasized, yet positive outcomes were identified regardless of the method. SH promotion should aim to better support adolescents' sexual identity reinforcement.

The marital relationship and health-related quality of life of prostate cancer patients and their spouses: A prospective, longitudinal study

AIMS

This study aims to measure any changes in the marital relationship during the first year after a diagnosis of prostate cancer, identify the demographic characteristics that influenced such changes, and measure changes related to health-related quality of life (HRQoL).

BACKGROUND

Knowledge is limited on the impact of a diagnosis of prostate cancer on the marital relationship and HRQoL of patients and their spouses.

DESIGN

A 1-year longitudinal study.

METHODS

Data were collected from five Finnish hospitals between October 2013 and January 2017. Of the 350 recruited couples (N = 700), 179 patients and 166 spouses completed the Marital Questionnaire and the RAND 36-Item Health Survey 1 year after diagnosis.

RESULTS

No major changes were found in the marital relationship during the follow-up period. The spouses reported statistically significant changes in their marital relationships, but the patients did not. Furthermore, changes in the marital relationship were not associated with the patients' HRQoL. Among spouses, emotional well-being was associated with changes in the marital relationship.

CONCLUSION

The marital relationship was relevant in terms of the spouses' HRQoL during the first year after a diagnosis of prostate cancer. Nurses and other healthcare providers should assess counselling and support provided to spouses individually.

Abstract CT171: Can supervised exercise impact on metabolic markers and physical activity during androgen-deprivation therapy in prostate cancer patients? - randomized controlled pilot trial

Introduction: Androgen-deprivation therapy (ADT) is standard in treatment of advanced prostate cancer (PCa). Common adverse effects include fatigue, weight gain, sarcopenia, and decreased libido leading to lowered quality of life (QoL). Supervised exercise improves overall QoL among PCa patients. Less is known, however, how it may affect metabolic adverse effects of ADT.The aim of the study was to explore the effect of exercise intervention on glucose and cholesterol levels, body composition, and to find out whether supervised exercise leads to greater physical activity in long-term compared to self-administered exercise in men with ADT.

Materials and methods: Altogether, 45 men were recruited. One man withdrew the consent at baseline and 5 dropped out during the study. Thus, 39 men completed the study. Subjects were randomly assigned into either supervised exercise for 3 months (n=27) or control group of self-administered exercise (n=17). In the supervised group, participants attended 1.5-hour group exercise session twice per week. Training program included both aerobic and muscle strength exercises. The 3-month intervention was followed by 3-month follow-up of self-administered exercise. Control group received the same introduction to exercise and training instruction as the supervised group but exercised independently for the entire study period. Fasting cholesterol, plasma glucose, and body composition were evaluated at the baseline, 3 months after randomization, and at the end of the study, 6 months after randomization. Physical activity during the study period was measured using activity bracelets (Polar A370). Study protocol was approved by Pirkanmaa hospital ethics committee (R18021) and registered to Clinicaltrials.gov (NCT04050397).

Results: Median total cholesterol increased during 6-month follow-up in both groups, but less in the supervised group compared to the control group (0.1 vs 0.4 mmol/l, respectively, p=0.02). LDL remained stable in supervised group but increased slightly in the control group (0 vs. 0.4 mmol/l, respectively, p=0.01). Fasting plasma glucose lowered slightly in both groups (-0.2 vs -0.4 mmol/l). Total active time per day was slightly higher in the supervised group compared to the control group after 3-month intervention (median 364 vs 293 min/day, respectively). This difference persisted after intervention stopped (median 331 vs 267 min/day, respectively). Median change in body fat percentage at 6 months was 0 in the supervised arm and -0.9 in the control arm. None of the participants dropped out due to exercise-related side-effects.

Conclusion: This pilot study showed that it is safe to perform strength exercise in men with ADT. Supervised exercise is likely more effective in mitigating metabolic adverse effect of ADT and inducing long-term changes in physical activity than self-administered exercise. Larger studies with longer follow-up are needed to investigate whether this leads to survival advantage.

Citation Format: Lauri Rantaniemi, Aino Siltari, Eeva Harju, Teemu J. Murtola. Can supervised exercise impact on metabolic markers and physical activity during androgen-deprivation therapy in prostate cancer patients? - randomized controlled pilot trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT171.

Men's experiences of the impact of penile cancer surgery on their lives: A qualitative study

OBJECTIVE

Surgery is the primary treatment for invasive penile cancer (PC). Postoperative changes in genital anatomy and function may lead to altered body and self-image, compromised sexual function and subsequent psychological problems. The aim of this study is to describe men's experiences of the impact of PC surgical treatment on their lives.

METHODS

The institutional databases of two Finnish university hospitals were searched for patients who underwent surgery for invasive PC between 2009 and 2019. Of 107 men, 29 agreed to an interview or a response letter. The data were analysed by thematic analysis.

RESULTS

The men experienced that their self-image had changed after PC diagnosis and treatment to a 'cancer-modified me'. They also experienced that physical symptoms after surgery defined their everyday, as well as sexual, lives and that the whole content of life changed.

CONCLUSION

Support and counselling for physical, mental, sexual and social factors should be part of the treatment of men with PC.

Health-related quality of life in patients with prostate cancer and their spouses: Results from a longitudinal study

PURPOSE

The purpose of this study was to explore changes in HRQoL (health-related quality of life) and identify the associated factors in patients with prostate cancer and their spouses during the year following their diagnosis of prostate cancer.

METHODS

The longitudinal study design consisted of 179 patients and 166 spouses, using discretionary sampling, at five Finnish central hospitals. Participants completed a self-reported RAND-36-Item Health Survey at three time-points: time of diagnosis and 6 and 12 months later. Changes in HRQoL were analysed using descriptive statistics and non-parametric tests. Linear mixed-effects models were used to identify the factors associated with the changes in HRQoL in the patients and their spouses.

RESULTS

On average, the HRQoL of patients with prostate cancer changed in physical functioning (p = 0.015), emotional well-being (p = 0.029) and general health (p = 0.038) were statistically significant over the 12-month study period. In spouses, statistically significant changes in HRQoL were not observed. Interaction between the age of participants and changes in HRQoL were statistically significant.

CONCLUSIONS

Findings in this study suggest that interventions aimed at improving the HRQoL of patients should support a few different dimensions of HRQoL for the patients themselves than for their spouses. Nurses should pay more attention to elderly couples.

Genotyping of clinically relevant human adenoviruses by array-in-well hybridization assay

A robust oligonucleotide array-in-well hybridization assay using novel up-converting phosphor reporter technology was applied for genotyping clinically relevant human adenovirus types. A total of 231 adenovirus-positive respiratory, ocular swab, stool and other specimens from 219 patients collected between April 2010 and April 2011 were included in the study. After a real-time PCR amplification targeting the adenovirus hexon gene, the array-in-well assay identified the presence of B03 (n = 122; 57.5% of patients), E04 (29; 13.7%), C02 (21; 9.9%), D37 (14; 6.6%), C01 (12; 5.7%), C05 (5; 2.4%), D19 (4; 1.9%), C06 (2; 0.9%), D08 (1; 0.5%), A31 (1; 0.5%) and F41 (1; 0.5%) genotypes among the clinical sample panel. The typing result was obtained for all specimens that could be amplified (n = 223; 97%), and specificity of the typing was confirmed by sequencing specimens representing each of the different genotypes. No hybridization signal was obtained in adenovirus-negative specimens or specimens with other viruses (n = 30). The array-in-well hybridization assay has great potential as a rapid and multiplex platform for the typing of clinically relevant human adenovirus genotypes in different specimen types.

Flow cytometry in comparison with mitotic index in predicting disease outcome in transitional-cell bladder cancer

The DNA content and S-phase fraction were measured by flow cytometry in 448 tumour biopsy specimens from transitional-cell bladder cancer (TCC). The samples were also analyzed for mitotic index, WHO grade and papillary status, and histological and flow cytometric data were then correlated to clinical behaviour of tumours during a mean follow-up period of 9.9 years. TNM classification, WHO grade, papillary status, mitotic index, DNA ploidy and S phase fraction were significantly interrelated. Twenty-four percent of tumours showed heterogeneous DNA indices when measured from multiple samples (measured in 94 cases). Of the histological parameters, independent predictors of progression in superficial tumours were the S-phase fraction and mitotic index. In superficial tumours, S-phase fraction and the mitotic index included all the available independent prognostic information in survival analysis, whereas in muscle-invasive tumours T category was the most important prognostic factor. The results suggest that DNA ploidy has no independent prognostic value in transitional-cell bladder cancer, whereas proliferation indices (SPF, mitotic index) are important prognostic factors. Accordingly, malignancy classification of papillary bladder tumours can be based on proliferation indices alone. Nodular tumours run an unfavourable course and their malignancy grading by flow cytometry or by mitotic index is not relevant.

Grading of superficial bladder cancer by quantitative mitotic frequency analysis

A cohort of 270 superficial (stages Ta to T1) transitional cell bladder tumors was followed for more than 8 years. World Health Organization (WHO) grade, papillary status and 2 mitotic indexes were related to progression, recurrence-free survival and bladder cancer related survival during followup. Mitotic activity index and volume corrected mitotic index were significantly related to WHO grade and papillary status (p < 0.0001). WHO grade, papillary status and mitotic indexes were related significantly to progression in univariate analysis (p < 0.001) whereas in a multivariate analysis only volume corrected mitotic index included independent prognostic information (p < 0.001). Recurrence-free survival was related to volume corrected mitotic index in the entire cohort (p = 0.03) and in papillary tumors (p = 0.07). Bladder cancer related survival was related to WHO grade, papillary status, mitotic activity index and volume corrected mitotic index (all p < 0.0001). In papillary tumors mitotic activity index (p < 0.0001), volume corrected mitotic index (p < 0.0001) and WHO grade (p = 0.0036) predicted survival. In multivariate analysis mitotic activity index predicted independently recurrence-free survival in the entire cohort (p = 0.043) and in papillary tumors (p = 0.012). Bladder cancer survival in the entire cohort and in papillary tumors was related independently to volume corrected mitotic index (p < 0.001). The results show that superficial transitional cell bladder tumors can be efficiently categorized into prognostic groups by quantitative mitotic frequency analysis and the results provide a new classification system for superficial transitional cell bladder tumors.

Prediction of superficial bladder cancer by nuclear image analysis

A cohort of 270 superficial transitional cell bladder tumours (Ta-T1) was followed-up for over 8 years. WHO grade, papillary status and six nuclear factors were related to progression, recurrence-free survival (RFS) and bladder cancer-related survival (BS) during the follow-up period. Mean nuclear area (NA), standard deviation of nuclear area (SDNA), nuclear perimetry (PE), standard deviation of nuclear perimetry (SDPE), shortest nuclear axis (Dmin) and longest nuclear axis (Dmax) were significantly related to WHO grade and papillary status (P < 0.0001). All the nuclear factors were related significantly to progression in univariate analysis (P < 0.01) whereas in a multivariate analysis WHO grade (P < 0.0001) and papillary status (P = 0.048) included independent prognostic information. RFS was related to PE (P = 0.009), SDPE (P = 0.013), Dmin (P = 0.021), Dmax (P = 0.028) and SDNA (P = 0.029). In papillary tumours SDPE (P = 0.007) and Dmin (P = 0.024) predicted RFS. BS was related to WHO grade, papillary status, NA, SDNA, PE, Dmax, Dmin (all P < 0.0001) and to SDPE (P = 0.003). In papillary tumours PE (P < 0.0001), Dmax (P = 0.0022), Dmin (P = 0.0027), WHO grade (P = 0.0036), NA (P = 0.0005), SDNA (P = 0.0355) and SDPE (P = 0.0718) predicted BS. In multivariate analysis SDPE (P = 0.029) predicted RFS and survival was related to WHO grade (P < 0.001) and PE (P = 0.014) independently. In papillary tumours only Dmax (P = 0.001) predicted survival independently. The results show that superficial papillary transitional cell bladder tumours can be efficiently categorised into prognostic groups by nuclear image analysis and the results provide a new classification system for superficial papillary bladder tumours. Tumours with high nuclear factor values should be considered for radical primary therapy and adjuvant therapy after transurethral resections.

Tumour infiltrating lymphocytes as an independent prognostic factor in transitional cell bladder cancer

The prognostic value of tumour infiltrating lymphocytes (TIL) was assessed in a cohort of 514 patients with a transitional cell bladder cancer (TCC) during a follow up period of over 9 years. The density of TIL were positively correlated to WHO grade (P < 0.0001), non-papillary growth architecture (P < 0.0001), morphometric nuclear factors (P < 0.007) and volume corrected mitotic index (M/V index) (P < 0.0001). Dense TIL predicted progression in Ta-T1 tumours (P < 0.0006) whereas in a multivariate analysis they had no independent predictive value. Dense TIL were related to short recurrence-free survival in Ta-T1 tumours in a univariate analysis (P = 0.06) as well as in a multivariate analysis (P = 0.005). Dense TIL predicted unfavourable prognosis in the entire cohort (P = 0.0316) and in papillary tumours (P = 0.062) whereas in nodular tumours TIL were a sign of good prognosis (P = 0.0141). Also in T3-T4 tumours TIL were related to less aggressive behaviour of TCC (P = 0.0259). In a multivariate analysis including clinical stage (T-category), WHO grade, papillary status, six morphometric nuclear factors and M/V index dense TIL were a highly significant indicator of a favourable prognosis (P = 0.007). Particularly TIL categorized rapidly proliferating TCC into prognostic groups (P = 0.001). The results show that TIL are a sign of efficient host defence mechanisms in TCC and TIL predict a favourable prognosis in invasive TCC.

Clinical prognostic factors in transitional cell cancer of the bladder

A cohort of 537 patients with transitional cell cancer of the bladder (TCC) were followed up for a mean of 9 years and the clinicopathological data were related to prognosis. The T category (p < 0.0001), N category (p < 0.0001) and M category (p < 0.0001) were the most important clinical prognostic factors, followed by the age of the patient (p < 0.0001). Of the histological variables the WHO grade (p < 0.0001), papillary status (p < 0.0001) and the presence of R3-4 cells in voided urine (p = 0.0061) predicted unfavorable prognosis. In Ta-T1 tumors the WHO grade (p < 0.0001), papillary status (p < 0.0001) and the age of the patient (p < 0.0001) had a prognostic value in univariate analysis. In Cox's analysis independent predictors of survival were the T category (p < 0.0001), WHO grade (p < 0.0001), patient age (p < 0.0001), papillary status (p = 0.012) and the presence of symptoms before diagnosis (p = 0.033). In superficial tumors the WHO grade (p < 0.0001) and patient age (p < 0.0001) were independent predictors of survival.

Prognostic factors in nodular transitional cell bladder tumours

A cohort of 106 nodular transitional cell bladder cancers (TCC) were followed up for a mean of 9 years. Clinical stage, WHO grade, six morphometric nuclear factors and volume corrected mitotic index (M/V index) were correlated to progression and survival during the follow-up period. Nuclear factors were related to WHO grade with a borderline significance (p = 0.01-0.3) whereas the M/V index showed a highly significant relation to WHO grade. Neither nuclear factors nor the M/V index were related significantly to T-, N- or M-categories at the time of diagnosis. Progression in N- and M-categories was related independently to WHO grade whereas progression in T-category could not be predicted significantly by none of the variables included in this analysis. Survival was predicted by T-category (p = 0.0028), N-category (p = 0.0001), M-category (p = 0.0057) and M/V index (p = 0.010). In T1-T2N0M0 tumours survival was predicted by the Dmax (p = 0.015) and by the M/V index (p = 0.039). In multivariate survival analysis T-category (p < 0.001) had independent prognostic value. In T1-T2N0M0 tumours only the M/V index predicted survival independently (p = 0.007). The results show that only the proliferation rate in addition to T-category have prognostic significance in nodular TCC.

Prognostic factors in WHO grade 2 transitional-cell bladder cancer (TCC); a novel two-grade classification system for TCC based on mitotic index

A retrospective histological analysis has been carried out on 537 cases of transitional-cell bladder carcinoma, followed-up over a period of 9 years. In the first part of the study WHO grade 2 tumours were analysed and a number of independent factors predictive for survival identified. In a multivariate analysis the T category and M/V index (number of mitotic figures/mm2 neoplastic epithelium) were the most important prognostic factors. In a subsequent analysis of the whole series of 537 cases, overall the M/V index was not as important in predicting survival as the stage of the tumour. However, in superficial tumours (Ta-T1) subsequent analysis showed that the M/V index alone could be used to predict survival.

Transmediastinal esophagectomy and colon interposition without thoracotomy

In the Central Hospital of Central Finland (responsibility for 250,000 inhabitants) the technique of transmediastinal esophagectomy and colon interposition without thoracotomy was used on 19 consecutive patients in the years 1983-1988. Fourteen of the patients had a malignant and five a benign disease. The type of cancer was squamous cell cancer in 13, and adenocancer in 1 case. All five patients with a benign disease had an etiology of corrosion by various agents. Two of them had a spontaneous rupture. In three cases the perforation occurred as a complication of endoscopic dilatation. There were no peroperative but one postoperative death. Six minor complications were well under control. The survival rate of cancer patients is comparable with the results reported by other authors. All five patients with a benign disease are in excellent condition with a follow up time from 4 to 100 months (mean 44 mo).

Independent clinical, histological and quantitative prognostic factors in transitional-cell bladder tumours, with special reference to mitotic frequency

A cohort of 537 transitional-cell bladder cancers (TCC) was followed up for a mean of 9 years. Clinical stage, WHO grade, papillary status, 6 nuclear factors and volume-corrected mitotic index (M/V index) were related to progression and survival. Classic and quantitative prognostic factors were significantly interrelated (p less than 0.001). In Ta-Tl tumours M/V index predicted progression independently (p less than 0.001) and in the entire cohort progression was related independently to the M/V index (p = 0.0001) and to the WHO grade (p = 0.0022). In survival analysis, clinical stage (p less than 0.0001), M/V index (p less than 0.0001), WHO grade (p less than 0.0001), papillary status (p less than 0.0001) and nuclear factors (p less than 0.0001) were significant predictors. In papillary tumours, clinical stage (p less than 0.0001), M/V index (p less than 0.0001), WHO grade (p less than 0.0001) and nuclear factors (p = 0.0001-0.0133) were related to survival. In a multivariate analysis T-category (p less than 0.001), WHO grade (p less than 0.001), M/V index (p = 0.002) and papillary status (p = 0.034) predicted survival independently in the entire cohort whereas in papillary tumours T-category (p less than 0.001) and M/V index (p less than 0.001) were independent predictors. If tumours with pelvic lymph-node metastases or distant metastases at diagnosis were excluded from the analysis, T-category (p less than 0.001), M/V index (p less than 0.001) and WHO grade (p less than 0.001) were independent predictors. In papillary tumours T-category (p less than 0.001), M/V index (p less than 0.001) and WHO grade (p = 0.048) predicted survival. The results emphasize the importance of mitotic activity as a most important histological prognostic factor in TCC, second only to clinical stage. In Ta-TI tumours quantitative mitotic frequency analysis includes all the available independent prognostic information. Accordingly, TCC can be graded by mitotic frequency analysis in place of subjective grading systems.

Treatment with antioxidant and other nutrients in combination with chemotherapy and irradiation in patients with small-cell lung cancer

Eighteen non-randomized patients with small cell lung cancer (4 women and 14 men, mean age 60.4, SD 7.8 years) received in addition to conservation small cell lung cancer treatment antioxidant treatment with vitamins, trace elements and fatty acids. All patients were out-patients who, except for one were also treated with chemotherapy and/or irradiation at regular intervals at a university of central hospital. Five patients (28%) were in an advanced stage of the disease. At the end of the follow-up period (31.7.90) the median survival time for the whole group was 505 days. Fourteen (77%) of the patients survived for more than 12 months and six patients (33%) for more than two years. One patient (5%) survived more than five years. Eight patients (44%) were still alive with a mean survival time of 32 months at the end of the study. Ten patients succumbed earlier from progression of the disease. Antioxidant treatment, in combination with chemotherapy and irradiation, prolonged the survival time of patients with small cell lung cancer compared to most published combination treatment regimens alone. We also noticed that the patients receiving antioxidants were able to tolerate chemotherapy and radiation treatment well. Surviving patients started antioxidant treatment in general earlier than those who succumbed.

Is it possible to reduce the number of cerebral complications in carotid endarterectomy?

An effort was made to reduce the number of cerebral complications in carotid endarterectomy by focusing attention on the perioperative prevention of embolism and thrombosis in a prospective series of carotid endarterectomies (group I, n = 62) performed during a 24 months' period 1982-1984 in Tampere University Hospital. Controls were two other series of carotid endarterectomies (group II, n = 60, and group III, n = 60) comprising all 120 carotid endarterectomies carried out by other trained vascular surgeons in the same hospital during the years 1976-1984. During the first 30 postoperative days there were no deaths, one stroke and one TIA in group I. On the other hand there were three deaths, seven strokes and five TIAs in group II and four deaths, two strokes and three TIAs in group III. The number of cerebral complications in carotid endarterectomy was significantly less in the study group than in the control groups, and thus it was possible to reduce the perioperative complications in carotid endarterectomy possibly by pre- and postoperative drug treatment and routine intraoperative heparinization.

The protective effect of guar gum against stress-induced gastric ulcers in the rat

After the methodology had been studied and pilot studies conducted, nine groups of rats (10 rats per group) were fed solutions of different compositions via orogastric tube during induction of stress ulcers by resistant and a cold ambient temperature. The first group was a control group and received no feeding. Group 2 rats received distilled water, group 3 rats guar gum in distilled water, group 4 rats wheat flour (placebo) in distilled water, group 5 rats a 10% solution of glucose in distilled water, group 6 rats guar gum in the 10% glucose solution, group 7 rats wheat flour in the 10% glucose solution, group 8 rats a 30% glucose solution and group 9 rats cimetidine, intraperitoneally. Cimetidine provided the best protection against stress-induced ulcers. Guar gum in distilled water was almost as effective as cimetidine. Slightly fewer rats (30%) exhibited ulcers in the guar gum group than in the cimetidine group (40%). However, the ulcers in the guar gum group were larger than those in the cimetidine groups. The percentage of rats with ulcers and the percentage of the largest category of ulcers decreased as the energy content of the solutions changed from 10% to 30% glucose and from the control percentages. The protective effect of guar gum in distilled water was reduced when it was infused in a 10% glucose solution. In the latter solution, the effect of guar gum was similar to that in the rats given wheat flour (placebo) in a 10% glucose solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosing mammary cancer among an unselected Finnish population. Proposal for practical improvements

A total of 309 new mammary cancer patients were found in three successive years among 250,000 unselected Finns showing an annual rate of 1.08 cancers per 1000 women over 20 years of age. The main preoperative examinations were palpation and mammography. Palpation alone was performed preoperatively in 158 (51 percent) patients, palpation and mammography in 120 (38 percent), and the tumor was nonpalpable and found only in mammography in 31 (10 percent) patients. Fine-needle biopsy with palpation was performed in 191 (62 percent) patients and it confirmed definite malignancy in 89 cases, that is in 47 percent of the biopsied patients and in 29 percent of all patients. Mammography was most valuable in small tumors and fine-needle biopsy in large ones. The number of mammographies performed in the whole population per each new cancer case was 50; it seems unreasonable to increase the number of mammographies performed. It seems that the best way to improve the present preoperative evafuation of mammary cancer patients would be to perform a fine-needle biopsy under stereotactic guidance in every patient, and especially in those with a small tumor.

Patient satisfaction among day surgery patients in a central hospital

Satisfaction among patients treated one year before day surgery in a central hospital was studied by questionnaires, sent to 100 and returned by 70 patients. The satisfaction before surgery was positive in 74% and negative in 6% of the patients. Based on their experiences from surgery, patients satisfaction improved in 59%, and did not decline. The preferred waiting times to the out-patients examination and also between this and the operation day was 8-10 weeks. Except for patients unable to work (mostly orthopedic patients) very short waiting times were difficult. Hospital arrangements during the treatment day (before, during and after the operation) were considered very good by 56 to 62%, good by 31-40%, satisfactory by 1-6%, and weak by 0-1% of the patients. In all, 96% of the patients would be ready to return to day surgery. The two patients who would refuse had difficulties at discharge. Thus day surgery has had a positive effect on surgical patient satisfaction. The most important improvement was increased surgical availability. In order to improve satisfaction further, patients unable to work as a result of their surgical problem should be treated almost immediately.

Immediate effect of vagotomy on pancreatic insulin secretion

The effect of vagotomy and gastric resection on insulin secretion was examined by the glucagon stimulated C-peptide test in gastrectomy patients (n = 11) without truncal vagotomy and in total gastrectomy patients (n = 10) with truncal vagotomy. The test was performed twice in each patient: 10 minutes after the midline incision was made and then 60 to 90 minutes later when gastric resection or total gastrectomy was completed, during the reconstructive phase of the operation. Gastric resection without truncal vagotomy was followed by a higher increase (48%) in serum C-peptide concentration caused by glucagon stimulation than total gastrectomy with truncal vagotomy (13%). There was a significant (p less than 0.05) increase in the glucagon stimulated glucose-related C-peptide concentration in patients without truncal vagotomy, whereas truncal vagotomy inhibited this increase. These results suggest that truncal vagotomy will produce a reduction in stimulated insulin secretion in humans.

Postprandial blood concentrations of insulin-independent carbohydrate, galactose, in oral test after gastric surgery

In order to examine the postprandial blood concentrations of insulin-independent carbohydrates after gastric surgery oral galactose test (1.65 g/kg body weight in water, 33%, w/v) was performed in 55 symptomatic patients and in 5 healthy subjects. There were patients after total gastrectomy (TG) (n = 17), gastric resection with (GRS, n = 17) or without (GR; n = 12) selective vagotomy, and after proximal selective vagotomy (PSV, n = 9). The patients had immediately after drinking the test solution a 2- to 5-fold higher blood galactose concentration than the healthy subjects. The TG patients had the most rapid, the healthy subjects the slowest and the GR and GRS patients an intermediate rapid, immediate increase of blood galactose concentration. The TG patients showed a plateau 40-60 min and a decrease 60-90 min after the start of the test. The PSV patients showed a plateau 60-90 min after the commencement of the test. The GR and GRS patients and the healthy subjects had a continuous increase in blood galactose concentration during the whole test period, but the maximal point 90 min after the drinking of the solution was lower in the GRS than in the GR patients and lowest in the healthy subjects. The PSV patients had a lower blood galactose curve than the TG, GRS and GR patients but higher than the healthy subjects except the plateau 60-90 min postprandially.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and metabolic effects and wound healing metabolism in controlled total parenteral nutrition with high vs. low nitrogen content for seven days after abdominoperineal rectum resection for carcinoma

The clinical, metabolic and anthropometric effects and wound healing metabolism of two regimens of total parenteral nutrition with different amount of nitrogen low, 0.1 g, and high, 0.3 g/body weight kg/day were examined in this prospective double-blind study in two groups of ten patients subjected to abdominoperineal rectum resection for carcinoma for seven postoperative days. The results showed that the high nitrogen infusion associated with metabolic stress indicated by high excretion of urea, high level of serum urea and by a higher frequency of complications. Five patients of the high and one of the low nitrogen group showed complications (p less than 0.05). Further, the metabolic load, complications and high nitrogen infusion associated with higher body temperature, degree of fatigue, levels of C-reactive proteins, leukocytosis and lower of hand pressure force than found in those with low nitrogen infusion. The patient with low or high nitrogen infusion had similar parameters in wound healing metabolism of incision and stoma. The patients with complications showed a reduced stomal hydroxyproline concentration on the third postoperative day (p less than 0.05) and an increase of stomal and wound hydroxyproline and DNA on the seventh postoperative day (p less than 0.05). It is concluded that nitrogen amount of 0.1 g body weight kg/day is a better and a good alternative as compared to 0.3 g in total parenteral nutrition after major abdominal surgery for carcinoma.

Late results of surgical and nonoperative treatment of carotid stenosis. Eighty-four patients documented by angiography in 1974-1976

The long-term results of carotid endarterectomy are controversial. Here we report the late results of 44 surgically and 40 non-surgically treated patients with carotid stenosis documented by angiography in 1974-1976. The groups were similar with respect to sex-distribution, age, length of follow-up time (median 123.0 and 130.0 months in the surgical and non-surgical groups, respectively) and the occurrence of risk factors. Hypertension was more frequent (p less than 0.05) in the surgical group, as was medical treatment, mostly anticoagulants (p less than 0.06). The angiographic findings were also more severe in this group (p less than 0.001). During the follow-up period the occurrence of cerebrovascular complications (death, stroke and/or TIA) was more frequent in the nonoperated than in the operated group; however, survival of the patients was similar, as the cardiovascular deaths were an equalizing factor. The quality of life in patients alive examined for clinical and neurologic status and by neuropsychological tests and interview was similar, except that the operated patients were more satisfied. The progression of atherosclerosis in the carotid artery assessed by Duplex scanning was more frequent in the nonoperated group. Differences in medical treatment did not explain the results. Thus it is concluded that the late results were better in the operated patients with carotid stenosis than in the nonoperated ones.

Early cerebral complications in carotid endarterectomy: risk factors

Three hundred and thirty one carotid endarterectomies were performed on 279 patients during a period of twenty years from 1965 to 1984. The indication for surgery was transient ischemic attack in 67.4%, stroke in 22.7% and asymptomatic carotid stenosis in 10.0% of the operations. The overall major cerebral complication rate attending the operation was 9.6%. During the last four years' period from 1981 to 1984 the procedure morbidity was 3.6% and there was no mortality. Postoperative complications comprised 31 ipsilateral strokes and one contralateral stroke; the complications occurred during the first 24 hours in 28 cases and on the fourth or fifth day in four cases. Of these patients 11 succumbed to internal carotid thrombosis, one to cerebral infarction without thrombosis and one to intracerebral hemorrhage. The associated factors for major complications were analyzed retrospectively in the light of 32 parameters. Patients of advanced age, patients with type II diabetes mellitus, elevated serum triglycerides, high-grade stenosis or occlusion of the contralateral carotid artery, negative smoking history and those undergoing a second operation proved to be at high risk of early postoperative cerebral complications. These complications can be reduced by intraoperative use of heparin, preoperative ASA treatment and a short clamping time. Also peroperative use of shunt is obviously of benefit.

Metabolic problems after gastric surgery

The findings on dumping syndrome (DS) are not consistent considering its relations with age, sex, weight/height, smoking habits, race, dose of oral glucose, the time elapsed since surgery, the function of exocrine pancreas nor the duration of ulcer symptoms. The patients after total gastrectomy (TG) may present relative postprandial lack of insulin. As a sign of long-term hyperglycemia elevated HbA1 has been measured in DS patients. Oral galactose test may reveal new features of DS. Abnormalities in splanchnic blood circulation as well as release of intestinal hormones are involved with DS. Dietary habits including fibers, pectin and guar gum, play a central role in the prevention and treatment of DS. In unresponsive cases several operative methods have been applied with success. Alkaline reflux gastritis is most often seen after B II and I reconstructions and after pyloroplasty. Chronic diarrhea follows mostly after truncal vagotomy. Ten to 50% of patients after gastrectomy (GE) waste 10 to 20% of their body weight because of decreased food, energy, vitamin and mineral intake caused by eating-related symptoms. Vitamin and mineral supplements, a small snack 20 min before the major meal, digestive enzymes, treatment of colonization with antibiotics and protein foods may help. About 50% of GE patients show iron deficiency anemia. Easily dissolved iron between meals with ascorbic acid give the most effective response. Deficiency of vitamin B12 or of folate may develop as megaloblastic anemia. B12 supplement and antibiotics are effective in bacterial overgrowth, but surgical correction is necessary in troublesome blind loop. Folic acid deficiency is corrected by oral folic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical pharmacokinetics of iron preparations

The principle of iron conservation is the basis of iron metabolism; the normal basal loss of iron from the body is about 1 mg daily in a 70 kg man and 0.8 mg in a 55 kg woman. Iron is lost mainly by the menstrual and gastrointestinal routes. The total iron requirement during pregnancy is 800 mg; in the last month the requirement may amount to 7 to 8 mg/day. Supplementary iron is recommended for many menstruating women, and during the latter part of pregnancy. Correct fetal iron metabolism is ensured by proper maternal iron status, although there are contradictory opinions and findings about the relationship between maternal and fetal iron metabolism. Preterm infants fed on breast milk have a negative iron balance, and require an iron intake of about 0.6 mg/kg/day, and 3.4 mg/1 g haemoglobin, to compensate for intestinal and venesection iron losses, respectively. The absorption of supplementary iron by the preterm infant is a linear function of intake. Preterm infants do not require iron supplements when given repeated blood transfusions. During lactation the total iron losses of the mother are 1 mg/day, and thus no supplementary iron is needed if the iron metabolism has been in balance during the pregnancy. Serum ferritin concentration decreases continuously when iron stores in the body are reduced, and totally empty iron stores are the only known reasons for low serum ferritin concentration. Despite depleted iron stores, serum ferritin concentration can be normal or higher than normal in protein-energy malnutrition, up to 3 months after major surgery, in acute liver damage, in some patients with prolonged hyperglycaemia due to diabetes mellitus, in acute lobar pneumonia, active pulmonary tuberculosis and rheumatoid arthritis on gold therapy, in sepsis secondary to marrow hypoplasia induced by chemotherapy, in heavy drinkers and for a few days after myocardial infarction. In haemochromatosis, iron is deposited in liver (producing fibrosis), pancreas, endocrine glands and heart. The rise in the level of iron in the body is due to increased absorption and/or increased intake. This pathology may occur in transfusions, in alcoholism (especially when alcoholic beverages are contaminated with iron and the diet is low-protein), in several liver diseases, in congenital transferrin deficiency and in idiopathic disease. Patients susceptible to haemochromatosis should receive a low-iron diet. Serum ferritin determination may be helpful in early identification of susceptible members of a family with idiopathic familial haemochromatosis, but transferrin saturation is not a good indicator of either iron depletion or iron overload.(ABSTRACT TRUNCATED AT 400 WORDS)

Mammographic and palpation findings in the irradiated spared breast

Between 1983 and 1987, 22 women underwent breast-preserving treatment for T1 (n = 19) or T2 (n = 3) cancer. Axillary surgery was performed in 17 patients and axillary node "sampling" in one patient, while 4 patients had no axillary surgery. Radiotherapy was begun no later than six weeks after operation. The patients had the first post-treatment follow-up examination at 1 month to 41 months after irradiation. Six of the patients had more than one follow-up examination. According to the length of the follow-up period, there were two different groups of patients. Fourteen patients had the first follow-up examination at 1 month to 10 months after completion of radiation treatment. Eleven breasts (79%) had solid consistency as well as radiological edema. Six of the breasts had signs of severe edema seen during the first 6 months. At the second or third examination, if made after 10 months, the signs of edema decreased or disappeared. Eight patients examined for the first time at 12 to 41 months after radiation treatment had no radiological signs of breast edema and only 3 of the breasts were solid. The present results suggest that post-treatment mammograms are not useful during the first 6 months after irradiation and that the value of palpation is limited to at least 10 months; in selected patients these periods can be considerably longer.

Late carotid restenosis: aetiologic factors for recurrent carotid artery stenosis during long-term follow-up

During a fourteen-year-period 257 patients underwent carotid endarterectomy in an unselected population of 700,000 inhabitants. The incidence of haemodynamically significant restenosis was 13.5% in 133 vessels in 116 patients studied by duplex scanning 28 to 209 months following carotid endarterectomy. The most striking differences between patent and restenosed cases were in serum cholesterol, triglyceride and HDL-cholesterol levels. The patients with a long-term low cholesterol (less than 6.5 mmol/l), low triglyceride (less than 1.42 mmol/l) and high HDL cholesterol (greater than 1.0 mmol/l) levels had significantly less high grade restenosis (P less than 0.05). Apolipoprotein A-I and B had no significant effect, but if the lowest limit of normal apolipoprotein A-I level was considered as 1.27 g/l the difference was significant. The frequency of a high-grade restenosis in patients with diabetes mellitus and coronary heart disease was not significantly increased, but supports the view that these are risk factors in the development of atherosclerotic changes in an operated carotid artery. The incidence of recurrent stenosis appears to be unrelated to hypertension, claudication, obesity, smoking, operative factors or to the indication for surgery. Men were more prone than women to get a high-grade restenosis. Postoperative treatment with acetylsalicylic acid was most effective, the incidence was only half of that expected, whereas the anticoagulants or a combination of acetylsalicylic acid and dipyridamole were of no benefit. Haematocrit, RBC, platelet count and thrombocrit were contradictory.

Malignancies in the families of patients with gastric polyps

The present series consists of 155 patients with gastric polyps who attended the Central University Hospital of Tampere/between 1972 and 1983/but who did not develop gastric malignancies during the follow-up. 93 patients with non-ulcer dyspepsia served as controls. Both the experimental and control patients were interviewed with the help of a schedule as to the occurrence of malignancies among their family. The family was defined as parents, grand parents, brothers, sisters and children. There was a total of 961 members in the families of the study patients and 755 in the families of controls. In the families of the men with gastric polyps, the frequency of intestinal malignancies as a percentage of all malignancies was higher than in the controls, 10.3 and 2.9 percent, respectively (p less than 0.01). The frequency of gastric malignancies in the families of the women with gastric polyps was higher than in the controls and in men, 6.2, 3.1 and 2.4 percent, respectively (p less than 0.05, and p less than 0.025). The frequencies of all malignancies were similar in the study and control families. Thus there seems to be some family -related accumulation of intestinal malignancies in men and of gastric malignancies in women with gastric polyps.

Vitamin D and calcitonin treatment in patients with femoral neck fracture: a prospective controlled clinical study

The effects on general and bone metabolism of femoral neck fracture patients of 0.25 micrograms alpha-calcoid given orally twice daily (n = 9) and 25 micrograms calcitonin given subcutaneously 30 times (n = 10) in 10 weeks were studied against a control (n = 11). Bone histology and histomorphometry showed non-age related osteoporosis in 30% and osteomalacia in 22% of the patients studied. Impaired serum vitamin D status was found in 47-88% of patients, secondary hyperparathyroidism and increased serum parathyroid hormone in 59% and decreased serum calcitonin levels in 69%. On histology, normal findings and non-age related osteoporosis on histology were associated with low serum levels of 25-hydroxyvitamin D3, 1,25- and 24,25-dihydroxyvitamin D3. Very high serum levels of 1,25-dihydroxyvitamin D3 and low levels of 25-hydroxyvitamin D3 occurred in fracture patients with osteomalacia. Calcitonin improved calcium balance, reduced osteoporosis and increased the serum 1,25- and 24,25-dihydroxyvitamin D3 levels but had no effect on osteomalacia. Vitamin D reduced osteomalacia, slightly increased the serum 1,25-dihydroxyvitamin D3 concentration and decreased serum levels of parathyroid hormone. Both treatments gave a similar slight decrease in serum calcitonin concentrations. A mechanism of action for the treatments is suggested.

High serum lactic acid concentration after laparotomy and peritonitis in iron stores depletion. An experimental study on the rat

Total depletion of iron stores with a moderately decreased blood hemoglobin concentration (114 x 10 vs. 155 x 12 g/l in controls, n = 28) was produced in rats (n = 28) by rearing them for six weeks on an iron free diet, in iron free cages, starting at two weeks of age. The controls were treated at the same time in same conditions, except that they were given a normal supply of dietary iron. In all rats laparotomy and peritonitis by ligation and puncture of the caecum were carried out with ether anesthesia. Postoperative mortality and blood lactic acid concentration were followed for 120 minutes after the procedure. Postoperative mortality (8 of 28, 29% vs. 1 of 28, 4%) and blood lactic acid concentration (3.3 x 0.3 to 3.6 x 0.5 vs. 1.4 x 0.1 to 1.8 x 0.2 mmol/l) were higher (p less than 0.001) in the experimental group than in the control animals. The surviving rats (2.0 x 0.1 to 2.1 x 0.2 mmol/l) had a lower (p less than 0.001) blood lactic acid concentration than those who died (5.6 x 0.5 to 6.1 x 1.1). The results suggest that total lack of iron producing a moderate decrease of blood hemoglobin concentration creates a significant risk in abdominal surgery and focus the activation of the anaerobic energy yielding process.

Empty iron stores as a significant risk factor in abdominal surgery

The mortality and morbidity in abdominal surgery were investigated in two groups of patients, one with empty (N = 228) and the other with normal (N = 220) iron stores before operation. The estimation of body iron stores by measurements of serum ferritin concentration assumes that the only reason for a low ferritin value is an empty iron store. The results showed that the period of hospital treatment was shorter and the number of complications, especially infections, fewer, in patients with normal as compared to empty iron stores before the operation (p less than 0.001). These differences were especially striking in patients subjected to gastric or large bowel surgery. The results were not explained by differences in sex, age, serum albumin, or clinical anemia. The complications were not predictable from preoperative serum albumin, alkaline phosphatase, or alanine amino transferase levels. Among patients with postoperative complications those with preoperative empty iron stores also had a lower preoperative blood hemoglobin concentration (127 +/- 10 g/liter) than those with normal preoperative iron stores (136 +/- 9 g/liter). Thus it is speculated that the mechanisms behind postoperative complications due to preoperative empty iron stores might be a decrease in tissue oxygenation, resulting in an increased fatigue while working, decreased contractile capacity of the respiratory muscles, and a decrease in immune function. Thus a measurement of serum ferritin concentration and correction of empty iron stores is recommended before abdominal surgery.

Nutritional state after colon interposition for benign oesophageal disease

The nutritional state of 32 patients after (mean 66 months) colon interposition due to benign oesophageal disease was examined. Forty-four per cent of the patients had depleted iron stores (low serum ferritin concentration). Serum iron and blood haemoglobin concentrations were lower (P less than 0.001) in those with low than in those with normal serum ferritin concentration (115 +/- 12 g/l and 15 +/- 5 mumol/l vs 135 +/- 12 g/l and 23 +/- 9 mumol/l). Most very low blood haemoglobin concentrations (less than 110 g/l) were found in patients with depleted iron stores. Eighteen patients had serum albumin concentrations slightly below (35-39 g/l) the normal range, and two other patients had values less than 35 g/l. The patients had less dietary iron (13 +/- 6 mg/d) than age- and sex-matched controls (19 +/- 7 mg/d), but the intake of patients with depleted iron stores (12 +/- 5 mg/d) was similar to that of patients with normal iron stores (14 +/- 6 mg/d). Symptoms and/or the replacement of colon graft anti- or isoperistaltically did not have any significant association with the nutritional status, only slightly reduced blood haemoglobin and serum albumin concentration were found among the symptomatic patients and the patients with an antiperistaltic graft. Iron therapy and protein supplements, eg, from milk, egg, soy and meat, are recommended as the dietary treatment. To improve the nutritional status a short intra-abdominal colon graft loop anastomosed to the proximal stomach instead of long loop with an antral anastomosis of the present patients is suggested.

Decreased galactose absorption in dumping after colon interposition

Intestinal absorption was examined using an oral galactose test in colon interposition patients with dumping (no. 4) and without symptoms (no. 5). Normal subjects (no. 5), and patients after total gastrectomy (no. 7) and gastric resection (no. 4) served as controls. Galactose is absorbed in the same way as glucose, but does not stimulate insulin secretion. Colon interposition patients presented abnormally rapid postprandial transit and absorption for 20 minutes after the meal. After this rapid phase, colon interposition patients with dumping demonstrated a strong decrease in absorption rate, whereas the asymptomatic patients presented a normal rate during the whole follow-up period. The elimination of galactose from the blood was studied in eight patients after intravenous infusion of galactose; the disappearance was linear during 10 to 30 min after injection and did not explain the differences in blood galactose levels in the oral galactose test. We suggest a reactive reflux back to the intra-abdominal colon graft loop in the avagotonic intestinal tract as the mechanism for the differences in absorption. The most likely reason for this is the rapid initial phase transit through the coloantral anastomosis and pyloroplasty. To normalize postprandial transit and absorption as much as possible after colon interposition, a short intra-abdominal colon graft loop anastomosed to the posterior proximal stomach is suggested.

Body iron stores in patients subjected to surgery of the large bowel

Iron stores as estimated by serum ferritin concentration were studied in 40 patients subjected to colon surgery in reference to postoperative complications and restoration of iron stores, as well as to dietary and supplementary iron. The results showed that empty iron stores are common in patients subjected to colon surgery; 40 percent of the patients had a total loss before the operation. Preoperatively empty iron stores were associated (P less than .01) with an increased risk of postoperative complications that were not explained by other nutritional parameters. Surgery of the colon did not affect serum ferritin concentration or iron stores acutely or long-term. Intake of dietary iron was determined by food recording for seven days in all patients and was compared to 40 controls. The preoperative hemorrhagia and lower daily intake of dietary iron (8 +/- 3 mg) in the patients than in the controls (14 +/- 4 mg) may explain the empty iron stores. However, patients with normal iron stores also had low amounts of dietary iron (9 +/- 3 mg). In 12 patients with empty iron stores the effects of ferrous sulfate (80 mg Fe++) three times daily for six weeks were studied. The patients responded well to the therapy. It is concluded that preoperatively empty iron stores are common in patients subjected to colon surgery, and that this raises the risk of postoperative complications. Colon operations are not followed by acute or long-term changes in serum ferritin concentration or iron stores. The restoration of iron is achieved by oral iron therapy.

Inflammation parameters in the diagnosis of acute appendicitis

The role of the common parameters of inflammation in the diagnosis of acute appendicitis was studied by measuring axillary temperature (Tax), blood leukocyte (Leuk) and lymphocyte fraction (Lymph), serum C-reactive protein (CRP) and ESR in 354 patients with clinical diagnosis of acute appendicitis. Laparotomy showed normal appendix in 97 cases, but deduction of 14 with other surgically correctable disorders gave the negative appendectomy rate 83/354 (23.4%). The appendix had perforated in 9.9%. Tax, Leuk, Lymph and CRP could significantly differentiate acute appendicitis from the other cases, with respective sensitivity (and false positive) percentages 88.7 (66.0), 78.5 (24.7), 84.4 (48.5) and 52.7 (24.7). Although such statistical differences are not particularly helpful in preoperative diagnosis of individual cases, none of the 37 patients with simultaneously normal Leuk, Lymph and CRP had obvious appendicitis (2 probably had incipient inflammation). If laparotomy had not been performed in these 37 cases, almost half of the unnecessary operations could have been avoided, thereby reducing the negative appendectomy rate to 15.2%, with 11.7% perforation rate.

The protective effect of nutrients against stress induced gastric ulcers in the rat

The first part of the study consisted of 110 rats in 11 groups with ten rats in each. Nine of the groups were fed nutrient solutions of different compositions, antacid and sucralfate through orogastric tube during induction of stress ulcer by restraint and a cold ambient temperature. One group served as a control group and received no feeding and the 11th group was given cimetidine intraperitoneally. The extensiveness of the stress effect was estimated in each group by the number of rats with ulcer as percentage, the mean number of ulcers in each rat, the mean distribution of ulcers of different sizes, the mean total of mucosal damage in each rat and the contribution of ulcers of a different size to the total mucosal damage. The results showed that cimetidine is an effective protector against stress ulcer. Guar gum, Intralipid (fat emulsion), egg protein and 30 per cent glucose are slightly weaker protectors than cimetidine but much stronger than 10 per cent glucose wheat flour and distilled water. Sucralfate increased the susceptibility to stress ulcer. The second part of the study consisted of 86 rats. It showed, that guar gum increased the healing rate of stress ulcers. During a 30 hour treatment period after four hours of stress, the rats fed guar gum (n = 30) showed a lower (p less than 0.001) number of ulcers than the control rats fed normal rat food (n = 26) or immediately after the four hours of stress (n = 30). The mechanisms suggested for ulcer prevention and increased ulcer healing rate found herein may be due to reduced acidity, increased local mucosal supply of energy and mechanical protection.

Postprandial hyperglycemia after different carbohydrates in patients with total gastrectomy

Eating related difficulties and symptoms and postprandial serum glucose levels were studied in 11 patients (44 to 70 years old) five to 48 months after total gastrectomy and Roux-en-Y reconstruction for carcinoma of the stomach with no signs of metastasis or residual tumor. Three tests were used. The first contained 150 milliliters of 50 per cent glucose alone, the second had 150 milliliters of 50 per cent glucose with 5 grams of guar gum (viscose dietary fiber) and the third was a vegetable meal containing 75 grams of glucose. All of the patients with total gastrectomy had eating related symptoms, such as dumping and difficulties with the large volume of a meal. They had to eat small meals and the most usually experienced postprandial symptoms were abdominal pain, nausea and faintness. The postprandial serum glucose level was highest after drinking glucose alone and the lowest after eating the vegetable meal (as the highest 9.4 +/- 2.0 and 6.2 +/- 1.6 millimole per liter, respectively, 50 minutes postprandially, p less than 0.01). Hyperglycemia was associated with nausea, sweating, faintness, reduction of blood pressure and increase of pulse rate. The large volume of the vegetable meal produced difficulties (dysphagia and abdominal distension) in eating for everyone except one patient. Guar gum eaten with glucose reduced the postprandial hyperglycemia near to the level found after the vegetable meal. Also, the symptoms experienced after glucose with guar gum reduced from that after glucose alone, five patients became symptomless. Four of these five patients have supplemented guar gum regularly for several months into their daily meals with the result of reduction of the postprandial subjective symptoms. The dose has been adjusted individually from 2 to 7 grams of guar gum three times daily. Loose stools and diarrhea may occur at the beginning. These are avoided by a gradual increase of the dose during an adaptation period of two weeks. Sometimes glucose with guar gum may result in hypoglycemia with prolonged symptoms after immediate hyperglycemia. It is concluded that guar gum gives a possibility to avoid the symptoms related to a large volume of a meal and to reduce those produced by a high glucose content of a meal in patients after total gastrectomy. Guar gum also works in practical prolonged use when the dose is estimated from postprandial symptoms.

Effect of atropine on insulin secretion in healthy subjects

The effect of an anti-cholinergic drug (atropine) on insulin secretion was studied in a double-blind manner by the glucagon C-peptide secretion test in five healthy subjects and controlled with saline only (placebo) in four subjects. Blood C-peptide increased only by 157% in the group given atropine and by 252% in the group given placebo. The blood glucose concentration increased by 25% and 32%, respectively. Thus, it is concluded that the cholinergic system, probably through the vagus nerve, has an insulin secretion stimulating effect. The results also suggest that denervation of the vagus nerve, e.g. in gastric surgery, may partly explain post-prandial hyperglycaemia particularly found in dumping.