Preoperative Carbohydrate Antigen 195 (CA195) and CEA Serum Levels as Prognostic Factors in Patients with Colorectal Cancer

We evaluated in 214 patients with primary colorectal cancer the prognostic value of the preoperative serum levels of CEA and CA195. For CEA these levels were above the cutoff of 6 ng/ml in 31.3% of patients, whereas for CA195 they were higher than 12 U/ml in 35.9% of patients. The simultaneous use of both antigens increased the sensitivity to 49%, which was significantly higher than that of CEA (p<0.001) and CA195 (p<0.01) taken singly. The mean preoperative CEA levels were significantly (p<0.001) correlated with Dukes’ stage only, while there was a significant correlation between preoperative serum levels of CA195 and Dukes’ stage (p<0.001), grade of differentiation (p<0.01) and tumor location (p<0.05).

The results indicated that high preoperative serum levels of CEA and CA195 were associated with a shorter overall survival (p<0.0001). In addition, separate Cox multivariate analysis showed that preoperative CA195 was, after Dukes’ stage, the strongest factor to predict overall survival (p<0.0001).

Gender differences in benzodiazepines prescription in old age patients

Objectives

To assess the prescription of benzodiazepines (BZD) in elderly patients, and to explore any gender differences.

Methods

Six hundred and fifty-four patients (≥ 65) admitted in an emergency service of a general hospital due to a fall. BZD use information was collected (dose, half-life profile).

Results

BZD are significantly more prescribed to women (47.6%) than men (36.1%) (X2 = 8.097, P = 0.004). We conducted a logistic regression analysis using as dependent variable taking or not BZD and sex as the independent one, covariating the model by age. We noted that sex remains significant despite enter the age variable in the model (OR = 1.5, P = 0.013). A total of 21.6% of patients consumed intermediate or long half-life BZDs, appearing a greater tendency to prescribe such BZD to women (X2 = 3.606, P = 0.058). In the 58.0% of prescriptions, prescribed dose was higher than the recommended for the elderly. The percentage is significantly higher for men (70.0%) than women (53.1%). Furthermore, a total of 54 prescriptions (15.8%) were even higher than the recommended adult dose, with no significant differences between men and women.

Conclusions

We found evidence of a higher prescription of BZD in women independently of age. Despite not being recommended, prescription of intermediate or long half-life BZD continues, in a slightly higher manner in women. BZD are prescribed above the recommended dose for elderly in a large number of patients, especially in men. A considerable proportion of elderly patients (15.8%) consume BZD doses even higher than the recommended for adults.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Role of computed tomography and magnetic resonance imaging in aortobronchial fistula diagnosis following aortic coarctation reparative surgery. Report of two cases

Aortobronchial fistula (ABF) is an uncommon complication of aortic coarctation repair which may occur years after successful coarctation correction. It is invariably fatal if not diagnosed and treated. ABF diagnosis poses a challenge for clinicians and radiologists because of the difficulty in detecting the fistula and the risks associated with some of the diagnostic procedures. Two cases of ABF occurring 1 and 20 years after reparative surgery of aortic coarctation are reported. The advantages and disadvantages of different imaging procedures for the evaluation of patients with suspected ABF are reviewed and the role of computed tomography angiography and magnetic resonance imaging is underlined.

[Incomplete sagittal septum of the bladder]

OBJECTIVE

To describe an additional case of incomplete sagittal septum of the bladder.

METHODS

A case of incomplete sagittal septum of the bladder in a young, asymptomatic patient with paralysis of both lower limbs is presented and literature is briefly reviewed.

RESULTS

The diagnosis was made by intravenous urography performed five years after the accident that had caused the paralysis. Radiological evaluation showed an "apple heart" bladder with reduced capacity. No treatment was required.

CONCLUSIONS

Incomplete sagittal septum of the bladder is rare. To our knowledge, only 7 cases have been previously reported. Incomplete sagittal septum is like complete septum, but both cavities communicate anteriorly or distally, according to the direction and depth the septum protrudes into the bladder.

Percutaneous vertebroplasty: a special syringe for cement injection

Percutaneous vertebroplasty is an effective treatment for many focal vertebral lesions. Methyl methacrylate is too viscous to be handled without difficulty in the conventional way because injection time is short. The operator is left with little time and must fumble with multiple syringes. We describe a special screw-system syringe that decreases the effort needed to inject the cement. In addition, it can standardize the injection pressures and control the injected volume because the threaded plunger affords greater control of injection pressure and volume delivered than does the conventional method.

[Cancellations in pediatric surgery]

Cancellations have an important role in the effectiveness of the surgical schedule.

OBJECTIVE

Analyze the evolution of the cancellations during the years 1994-1997, after institution of several corrective measures.

MATERIAL AND METHOD

We started in 1994 together with the Quality Unit of the Hospital, a program to reduce surgical cancellations. It consisted in improvement of parents information, surgical schedule centralization, and increasing the awareness of the importance of constant improvement. Cancellations have been divided in: inevitables and inevitables, and analyzed for the entire Service and for each speciality.

RESULTS

A significant reduction of cancellations have been obtain (from 12.38% in 1992 to 3.35% in 1997). The inevitable causes (no presentation, inadequate preparation and lack of time in the surgical room) have shown the most improvement. Although the inevitable causes (intercurrent disease) were also significantly improved, after obtaining prior information of the health of the child, by telephone call or parents advise. ENT is the speciality with greatest improvement by significant reduction of the non presentation and intercurrent disease.

CONCLUSION

After corrective measures conjointly with a realistic surgical schedule, prior telephone call and improvement quality concept, have permitted a significant reduction of cancellations.

Preoperative carbohydrate antigen 195 (CA195) and CEA serum levels as prognostic factors in patients with colorectal cancer

We evaluated in 214 patients with primary colorectal cancer the prognostic value of the preoperative serum levels of CEA and CA195. For CEA these levels were above the cutoff of 6 ng/ml in 31.3% of patients, whereas for CA195 they were higher than 12 U/ml in 35.9% of patients. The simultaneous use of both antigens increased the sensitivity to 49%, which was significantly higher than that of CEA (p < 0.001) and CA195 (p < 0.01) taken singly. The mean preoperative CEA levels were significantly (p < 0.001) correlated with Dukes' stage only, while there was a significant correlation between preoperative serum levels of CA195 and Dukes' stage (p < 0.001), grade of differentiation (p < 0.01) and tumor location (p < 0.05). The results indicated that high preoperative serum levels of CEA and CA195 were associated with a shorter overall survival (p < 0.0001). In addition, separate Cox multivariate analysis showed that preoperative CA195 was, after Dukes' stage, the strongest factor to predict overall survival (p < 0.0001).

Cytoprotecting-effect of cimetidine: experimental evidence in the rat gastric mucosal lesions induced by intragastric administration of necrotizing agents

Contradictory data have been found on cimetidine-induced gastric cytoprotection. In our paper the effect of cimetidine administered intraperitoneally in doses of 2.5, 10 and 50 mg X kg-1, on: 1. The gastric acid secretory responses in 1 and 4 hr pylorus-ligated rats, and 2. The rat gastric mucosal lesions induced by intragastric administration of 0.6 M HCl, 0.2 M NaOH, 96% ethanol and 25% NaCl is discussed. It was found that: 1. Cimetidine dose-dependently inhibited the gastric acid secretion in 1 and 4 hr pylorus-ligated rats, but a dose of 2.5 mg X kg-1 did not exert any significant inhibition; 2. All doses of cimetidine significantly prevented the gastric lesion development induced by different necrotizing agents (0.6 M HCl, 0.2 M NaOH, 96% ethanol, and 25% NaCl); 3. The cytoprotecting dose of cimetidine was of 2.5 mg X kg-1; and 4. The duration of cimetidine-induced cytoprotection was 1 hr long before the administration of the necrotizing agent. These results suggest a real cimetidine-induced gastric cytoprotection.