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PubMed1976

[Behaviour of the lung as an organ of absorption and reaction when air-borne contaminants are inhaled (author's transl)].

The pulmonary resorption of air pollutants constitute a significant factor for the whole body burden of men, as can be shown for lead, SO2 and CO. Particle size as well as water and lipid solubility of the noxious agents are important variables for the extent of the interaction with the pulmonary surface. Main objects for the inhalative pollutants are the bronchioli terminales and the respiratory epithel. The electronmicroscopic investigations point out a specific irritability of these structures as far as lead, oxydants and fibers are concerned. Comparatively low concentrations of the agents produce, in chronic exposure, changes in the caliber of the small airways and widening of the ductus alveolares and the alveoli. In addition to the reduction of the inner lungsurface one observes a thickening of the diffusion barrier in loco through some harmful substances. A number of pollutants influence a primary cytotoxic effect on alveolar macrophages. Thereby the bacterial infection resistance of the lung is reduced; moreover the phagozytes play an important part for the detoxification of carcinogenic carbohydrates. Hence the lung functions as a resorptionorgan, as a protectionorgan and as an object of damage for various air pollutants.

Absorption↗
PubMed2005

Assessing and communicating the health and judicial impact of alcohol use.

BACKGROUND: Alcohol consumption places an increasing burden on health services, criminal justice agencies and private industry throughout the UK. Despite a national strategy to tackle alcohol-related harm, there remains a lack of epidemiology on alcohol use and related harms at local levels. Utilising national data sources and existing research studies, Regional Public Health Observatories are appropriately placed to calculate such measures and examine their relationship with deprivation. METHODS: For the North West of England, borough and health locality data were extracted from national sources. Alcohol consumption utilised lifestyle survey data and estimates of related harm were calculated by applying existing alcohol attributable fractions to deaths, hospital episodes and crime data. Contribution of alcohol to reduction in life expectancy was also calculated and all measures were correlated with deprivation. RESULTS: For the North West, the annual burden of alcohol was estimated at over 3700 deaths, 56,700 hospital episodes and 71,000 crimes. Annual alcohol-related death rates for men varied from 0.43 to 1.17 per 1000 between Local Authorities and there was a six-fold variation in alcohol-related crime rate between areas. For males, alcohol reduced life expectancy by more than five months in the area worst affected. For both sexes, more deprived areas had significantly higher levels of alcohol-related hospital episodes, crime, and contribution to reduced life expectancy. CONCLUSIONS: Alcohol-related harm requires urgent, multi-agency attention at local levels throughout the UK. Applying appropriate research methods to national data sources provides limited but valuable local measures of alcohol use and its impact on health and crime. Regional Public Health Observatories can facilitate partnership working through such provision of national intelligence tailored to support local and regional action. Application of these techniques also helps identify additional requirements for better local intelligence on health-related behaviours and the necessity for consistency across local health and behaviour surveys.

Adolescent↗
PubMed1993

The Mount Sinai cesarean section reduction program: an update after 6 years.

A six year follow-up evaluation of our original cesarean section reduction program is presented. While establishing obstetric practice guidelines was accomplished, two prerequisites remain critical: lowering cesarean utilization was to be accomplished without harm to mother or fetus, and a target rate was prospectively determined. The results after 6 years indicate that total cesarean rates of 10-12% can consistently be achieved without adverse outcome. Additionally, operative vaginal procedures were employed less that 3% of cases. Separate analysis of 580 breech deliveries failed to show an effect of route of delivery on mortality. This effort indicates that long-term reductions and cesarean utilization are possible with a comprehensive departmental program designed to accomplish achieving a target rate of 11%.

Breech Presentation↗
PubMed1977

Benzo[a]yrenedione/benzo[a]pyrenediol oxidation-reduction couples and the generation of reactive reduced molecular oxygen.

The ability of the isomeric quinone metabolites of benzo[a]pyrene, benzo[a]pyrene-6,12-dione, benzo[a]pyrene-1,6-dione, and benzo[a]pyrene-3,6-dione to undergo reversible, univalent oxidation-reduction cycles involving the corresponding benzo[a]pyrenediols and intermediate semiquinone radicals has been characterized. Under anaerobic conditions, all three benzo[a]pyrenediones are easily reduced to benzo[a]pyrenediols, even by mild biological agents such as NAD(P)H, cysteamine, and glutathione. The benzo[a]pyrenediols, in turn, are very rapidly autoxidized to the benzo[a]pyrenediones when exposed to air. Substantial amounts of hydrogen peroxide are produced during these autoxidations, and other reactive reduced oxygen species, such as the superoxide and hydroxyl radicals, are probably formed transiently as well. The benzo[a]pyrenediol-benzo[a]pyrenedione interconversions proceed by one-electron steps; the corresponsing semiquinone radicals can be monitored by electron spin resonance spectroscopy as inter mediates during these reactions carried out at high pH. Benzo[a]pyrenediones induce DNA strand scission when incubated with bacteriophage T7 DNA. This damage is modified by conditions which indicate that reduced oxygen species propagate the free-radical reactions responsible for the strand scission. Benzo[a]pyrenediones are electron-acceptor substrates for NADH dehydrogenase from Clostridium kluyveri. Catalytic amounds of these benzo[a]pyrene metabolites, together with this respiratory enzyme function as cyclic oxidation-reduction couples which link NADH and molecular oxygen in the continuous production of hydrogen peroxide. These data, together with preliminary results with cells in culture, indicate that benzo[a]pyrenediones are potentially harmful metabolites of benzo[a]pyrene, acting by processes which lead to their regeneration rather than depletion; nucleic acid and call damage is probably produced by the reactive reduced oxygen species resulting from such regenerative oxidation-reduction cycles.

Benzopyrenes↗
PubMed1991

Treatment of male pattern baldness and postoperative temporal baldness in men.

The use of plastic surgery techniques such as flaps and reductions has resulted in dramatic progress in the treatment of baldness. The operative indications are difficult because of the variety of baldness and the multiple techniques available. Surgeons place themselves at a disadvantage by refusing a specific technique, and this may harm the patient. Surgeons should establish a careful plan before undertaking the treatment of a patient, to make maximum use of the techniques that are available. We prefer flaps and reductions to grafts because of the decrease in the number of operations and time required to obtain a good result. We have described our personal classification, which takes into account the distribution of the hair, the density in each region, and the position of the frontal and temporal hairlines. This enables us to be more precise as to the indications and limitations of surgery. Different modern techniques have been described, concentrating on major reductions or scalp lifts as described by the author, which results in advancement of the crown 6 cm posteriorly and between 2 and 3 cm laterally. Dramatic results can be obtained if one or two vertical flaps are raised during the same operation. Vertical flaps provide a better result than horizontal flaps because they provide a deep android recession and natural forward hair growth. These techniques have the advantage of providing a rapid and aesthetic result after each operation as compared with punch grafts, which require long periods of time before obtaining a reasonable result. Finally, we propose a rapid, easy, two-stage procedure for extensive baldness that combines a one-stage preauricular flap with a scalp lift. The aesthetic result is good and may be completed by another reduction or by punch grafts.

Alopecia↗
PubMedDate not supplied

When should we stop screening?

CONTEXT: Although the age at which screening should be started is the subject of considerable debate, the question of when to stop has received little attention. COUNT: Days of life lost by stopping screening at various ages. CALCULATIONS: For each of three types of cancer (breast, cervical, and colon), we used life tables to calculate life expectancy at various ages for stopping screening and for continuing screening until death. The days of life lost by stopping screening is the difference in life expectancy between the two life tables for a specified age. DATA SOURCES: All-cause and cancer-specific mortality were obtained from the National Center for Health Statistics and Surveillance Epidemiology and End Results Survey (SEER). ASSUMPTIONS ABOUT BENEFIT: On the basis of randomized trial data, we used a 30% reduction in cancer-specific mortality for breast and colon cancer screening. Because there are no comparable data for cervical cancer, we assumed a 30% reduction in the mortality rate for the "best-guess" analysis and a 70% reduction in the mortality rate for the "best-case" analysis. We assumed that these benefits persisted for the elderly. ASSUMPTIONS ABOUT HARM: We assumed that there was no harm with screening. RESULTS: Given a starting age of 50 years, screening throughout life has a maximum potential life expectancy benefit of 43 days for breast cancer and 28 days for colon cancer. The average 75-year-old who stops either mammography or fecal occult blood testing would give up a maximum of 9 days. By stopping at age 80, she would give up a maximum of 5 days. Given a starting age of 20, Pap smear screening has a maximum potential benefit of 47 days in the best-case analysis and 7 days in the best-guess analysis. The average 75-year-old who forgoes Pap smear screening would give up a maximum of 3 days (best case) or 0.5 days (best guess). By stopping at age 80, she would give up a maximum of 1.5 days and 0.2 days, respectively. CONCLUSIONS: Even assuming that the mortality reduction with screening persists in the elderly, 80% of the benefit is achieved before 75 years of age for breast cancer, 80 years for colon cancer, and 65 years for cervical cancer. The small benefit of screening in the elderly may be outweighed by the harms: anxiety, additional testing, and unnecessary treatment.

Adult↗
PubMed2004

Effects of low nicotine content cigarettes on smoke intake.

Cigarettes with selective reductions in nicotine delivery have been considered as potential tools to prevent or treat nicotine dependence or to reduce harm by virtue of reduced nicotine and nitrosamine delivery. An important question is whether individuals smoke these products more intensively, as has been shown to occur with ventilated-filter cigarettes. To investigate this issue, we compared conventional highly ventilated filter cigarettes, having very low tar and nicotine yields when smoked by Federal Trade Commission method (1 mg tar, 2 mg carbon monoxide [CO],.2 mg nicotine), with low nicotine content cigarettes, manufactured from a genetically modified strain of tobacco, which had higher tar but lower nicotine yield (14 mg tar, 13 mg CO,.02 mg nicotine). A total of 16 cigarette smokers participated in two 8-hr sessions (order counterbalanced) during which they smoked each type of cigarette ad libitum. Expired-air CO, plasma nicotine, and smoking topography measures were collected. Subjects showed significant increases in smoking when using the highly ventilated filter cigarettes, and puff volume was significantly greater than with the low nicotine content cigarettes. Subjects achieved an expired-air CO level 74% as high as with the low nicotine content cigarettes; the latter produced CO levels similar to those measured at baseline when subjects smoked their habitual brands of cigarettes. Plasma nicotine levels obtained when subjects smoked the highly ventilated filter cigarettes also were significantly higher than when they smoked the low nicotine content cigarettes. These results indicate that the delivery of substantial amounts of smoke, with selective reductions in nicotine yield, appears to prevent compensatory smoking behavior. Further studies should determine whether similar results are obtained in naturalistic environments.

Adult↗
PubMed2004

Short shrift for the sane? The hospital management of self-harm patients with and without mental illness.

In recent years the British government has sought to target service provision both on people with severe enduring mental illness and on those considered to be at risk of suicide. The study reported here suggests these policies may have had unforeseen repercussions on services for people who self-harm but have no identifiable mental illness. This paper compares the hospital management of self-harm patients with and without mental illness. Over the years 1996-2000, a total of 4,329 self-harm patient attendances were recorded at the accident and emergency department of a British hospital. Whilst patients in 63.7% of attendances could reasonably have been considered to have some form of mental illness, we found that in the remaining 36.3% of attendances (where patients had no indicator of mental illness) a particularly poor standard of service was given. We suggest that if government targets for a reduction in the suicide rate are to be met, it is crucial that there should be marked improvements in services for all self-harm patients presenting at accident and emergency departments. However, in improving services we must be vigilant to the danger that targeting those with a mental illness may mean we fail to provide even basic levels of care for others.

Community Mental Health Services↗
PubMed2004

Chromate-reducing properties of soluble flavoproteins from Pseudomonas putida and Escherichia coli.

Cr(VI) (chromate) is a toxic, soluble environmental contaminant. Bacteria can reduce chromate to the insoluble and less toxic Cr(III), and thus chromate bioremediation is of interest. Genetic and protein engineering of suitable enzymes can improve bacterial bioremediation. Many bacterial enzymes catalyze one-electron reduction of chromate, generating Cr(V), which redox cycles, generating excessive reactive oxygen species (ROS). Such enzymes are not appropriate for bioremediation, as they harm the bacteria and their primary end product is not Cr(III). In this work, the chromate reductase activities of two electrophoretically pure soluble bacterial flavoproteins--ChrR (from Pseudomonas putida) and YieF (from Escherichia coli)-were examined. Both are dimers and reduce chromate efficiently to Cr(III) (kcat/Km = approximately 2 x 10(4) M(-1) x s(-1)). The ChrR dimer generated a flavin semiquinone during chromate reduction and transferred >25% of the NADH electrons to ROS. However, the semiquinone was formed transiently and ROS diminished with time. Thus, ChrR probably generates Cr(V), but only transiently. Studies with mutants showed that ChrR protects against chromate toxicity; this is possibly because it preempts chromate reduction by the cellular one-electron reducers, thereby minimizing ROS generation. ChrR is thus a suitable enzyme for further studies. During chromate reduction by YieF, no flavin semiquinone was generated and only 25% of the NADH electrons were transferred to ROS. The YieF dimer may therefore be an obligatory four-electron chromate reducer which in one step transfers three electrons to chromate and one to molecular oxygen. As a mutant lacking this enzyme could not be obtained, the role of YieF in chromate protection could not be directly explored. The results nevertheless suggest that YieF may be an even more suitable candidate for further studies than ChrR.

Amino Acid Sequence↗
PubMed1998

Investigating individual subjects and screening populations for asymptomatic carotid stenosis can be harmful.

OBJECTIVES: Trials suggesting that carotid endarterectomy in individual subjects with asymptomatic carotid stenosis reduces stroke risk have led to calls for screening. This study aimed to determine which groups might be harmed and which might benefit from a screening programme, and also to identify which individual subjects identified as positive for severe asymptomatic stenosis by carotid ultrasound are appropriate to put forward for further tests or procedures. METHODS: A probability model was used to estimate the outcomes of three screening strategies: carotid ultrasound followed by catheter angiography, or by magnetic resonance angiography (MRA), or ultrasound alone, followed by carotid endarterectomy if severe stenosis is detected. Information from the current literature was used to estimate sensitivity and specificity of ultrasound and MRA, risks of angiography and endarterectomy, and risk reduction after surgery for severe stenosis. For each strategy over a range of possible prevalences of severe asymptomatic stenosis, overall benefit to harm ratio was calculated, and number of strokes or deaths prevented or caused per 10,000 subjects screened. RESULTS: At the prevalence of carotid stenosis found in the general population (<1%) screening will cause more strokes than it prevents, even using the most optimistic published figures. Only at prevalences of over 20% are significant benefits seen, and then only in centres with high test sensitivity and specificity and very low angiographic and surgical risk. Groups with such a high prevalence have not yet been reliably identified. Screening individual subjects from high prevalence groups would have limited public health impact, with at best about 100 strokes prevented for every 10,000 screened at 20% prevalence. CONCLUSIONS: Investigating asymptomatic individual subjects for carotid stenosis may be harmful except in high prevalence groups. There is insufficient information about which these groups are, and at present screening cannot be recommended. Acting on a positive carotid ultrasound test in individual subjects

Adult↗
PubMed2005

Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy.

BACKGROUND: Bacterial infections are a major cause of morbidity and mortality in neutropenic patients following chemotherapy for malignancy. Trials have shown the efficacy of antibiotic prophylaxis in decreasing the incidence of bacterial infections, but not in reducing mortality rates. OBJECTIVES: This review aimed to evaluate whether antibiotic prophylaxis in afebrile neutropenic patients reduced mortality when compared to placebo or no intervention. SEARCH STRATEGY: Electronic searches on The Cochrane Cancer Network Register of Trials (2004), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to 2004) and EMBASE (1980 to 2004) and abstracts of conference proceedings; references of identified studies; the first author of each included trial was contacted. SELECTION CRITERIA: RCTs or quasi-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention, or another antibiotic to prevent bacterial infections in afebrile neutropenic patients. DATA COLLECTION AND ANALYSIS: Two authors independently appraised the quality of each trial and extracted data from the included trials. Relative risks (RR) or average differences, with their 95% confidence intervals (CI) were estimated. MAIN RESULTS: One hundred trials (10,274 patients) performed between the years 1973 to 2004 met inclusion criteria. Antibiotic prophylaxis significantly decreased the risk for death when compared with placebo or no intervention (RR, 0.66 [95% CI 0.54 to 0.81]). The authors estimated the number needed to treat (NNT) in order to prevent 1 death from all causes as 60 (95% CI 34 to 268). Prophylaxis resulted in a significant decrease in the risk of infection-related death, RR 0.58 (95% CI 0.45 to 0.74) and in the occurrence of fever, RR 0.78 (95% CI 0.75 to 0.82). A reduction in mortality was also evident when the more recently conducted quinolone trials were analysed separately. Quinolone prophylaxis reduced the risk for all-cause mortality, RR 0.52 (95% CI, 0.37 to 0.84). AUTHORS' CONCLUSIONS: Our review demonstrated that prophylaxis significantly reduced all-cause mortality. The most significant reduction in mortality was observed in trials assessing prophylaxis with quinolones. The benefit demonstrated in our review outweighs harm, such as adverse effects, and development of resistance, since all-cause mortality is reduced. Since most trials in our review were of patients with haematologic cancer, prophylaxis, preferably with a quinolone, should be considered for these patients.

Anti-Bacterial Agents↗
PubMed2001

Effects of nitric oxide and peroxynitrite on endotoxin-induced leukocyte adhesion to endothelium.

Leukocyte accumulation has been shown to be increased in sepsis. Moreover, in inducible nitric oxide synthase (iNOS) knockout mice, a further increase in leukocyte accumulation has been observed during sepsis, suggesting that nitric oxide (NO) may affect leukocyte/endothelial interaction. Accelerated peroxynitrite formation also occurs during sepsis. In the present study, the effect of peroxynitrite or NO on leukocyte adhesion to nitric oxide synthase (NOS)-inhibited or endotoxin-treated endothelium was examined. Bovine aortic endothelial cells were treated with either L-NAME or lipopolysaccharide (LPS) and interferon-gamma for 4 hr and subsequent leukocyte adhesion was measured. Both L-NAME and LPS treatment resulted in increased leukocyte adhesion compared with control. Neither a peroxynitrite donor, SIN-1, nor a direct NO donor, DETA-NO, had any effect on leukocyte adhesion to untreated endothelium. However, when the L-NAME or LPS-treated endothelial cells were treated simultaneously with either SIN-1 or DETA-NO, there was a significant reduction in leukocyte adhesion. Moreover, at the concentrations used in the present study, neither peroxynitrite nor NO showed harmful effects on normal cultured endothelial cells. These data demonstrating inhibition of leukocyte adhesion to endotoxin-treated endothelium suggest that peroxynitrite or NO may exert a beneficial effect during sepsis.

Animals↗
PubMed1985

Deoxyribonucleic acid homologies among 96 strains of ammonia-oxidizing bacteria.

DNA of 96 strains of the genera Nitrosomonas, Nitrosococcus, Nitrosospira, Nitrosolobus, and Nitrosovibrio was isolated and analysed spectrophotometrically. Percentages of guanine plus cytosine (G + C) content, genome sizes, and DNA-DNA homologies were determined. The results indicated the presence of eight Nitrosomonas species, three or four Nitrosococcus species, five Nitrosospira species, and two species of both Nitrosolobus and Nitrosovibrio. DNA homologies between strains of a separate species ranged from 56-100%. Average homologies between strains of different species were 33% in Nitrosococcus, 36% in Nitrosomonas, 37% in Nitrosolobus, 40% in Nitrosospira, and 42% in Nitrosovibrio. Average homologies between species of different genera were 33% and thus not significantly above the background value of 30% detected between DNA of ammonia-oxidizing bacteria and Escherichia coli. Genome sizes ranged from 1.90 - 2.74 X 10(9) dalton in Nitrosomonas, 2.09 - 2.37 X 10(9) dalton in Nitrosococcus, 1.87 - 2.15 X 10(9) dalton in Nitrosospira, 1.92 - 2.10 X 10(9) dalton in Nitrosolobus, and 1.91 - 2.15 X 10(9) dalton in Nitrosovibrio. Differences in genome sizes were in accordance with DNA homologies.

Ammonia↗
PubMed1999

[Correction of posttraumatic deformities. Principles and methods].

The reason for inadequate results after the treatment of spinal lesions may be due to the misinterpretation of the type of lesion thus leading to incorrect therapy. Frequently the bio-functional construction principles of the spine are ignored and biomechanically based reconstruction of the spine is not done. Unsuitable approaches and fusion techniques may result in insufficient stabilisation with predictable failure. In both the first surgery and the salvage procedure, the principles of the load-sharing system as well as the posterior tension band principle must be respected. These principles and the surgery techniques are demonstrated in individual examples. Special attention is drawn to the impact of segmental deformities on the general statics of the spine. Frequently, residual deformities with the typical clinical picture lead to decompensation and the reduction of efficiency only after ten to fifteen years.

Adolescent↗
PubMedDate not supplied

A brief group treatment for the modification of denial in child sexual abusers: outcome and follow-up.

We investigated whether brief structured group treatment could produce a reduction of denial of sexual offenses in males convicted of sexually offending against children. Such denial can additionally harm victims and often precludes admission into sex offender treatment programs, thus ruling out an opportunity to decrease the potential of reoffending. The group treatment contained elements of victim empathy, cognitive restructuring, sex education, assertiveness and social skills, education about sex offender therapy, and a discussion of the possible consequences of continued denial. Seventeen child sexual offenders in denial were run in two groups. Despite an average length of denial of nearly two years, by post-treatment the majority of offenders had come out of denial. Moreover, follow-up denial data indicated continued admission, and above-average compliance with subsequent sex offender therapy. Although the lack of an experimental design precludes causal inference, these results are suggestive of an effective method for modifying denial in sex offenders against children.

Adolescent↗
PubMed2000

The long-term effects of pre-treatment with activated protein C in a rat model of compression-induced spinal cord injury.

OBJECTIVES: Recently, we demonstrated that activated protein C (APC) can lessen the severity of spinal cord injury (SCI) in rats during the acute and subacute phases. The purpose of the present study is to determine the long-term effects of pre-treatment with APC following SCI in rats. METHODS: The motor function of rats was assessed using the inclined-plane test during 8 weeks after SCI, and the grid runway test 7 weeks after the trauma. Somatosensory evoked potentials (SEPs), brainstem-derived motor evoked potentials (B-MEPs) and corticomotor evoked potentials (CMEPs) were used to quantify axonal function 8 weeks after SCI. Morphometric analysis of the spinal cord lesion was carried out to determine lesion size. Twelve male Sprague-Dawley rats were randomly allocated to either APC (25 IU/kg) or saline group and then subjected to 20 g compression injury of the spinal cord for 20 min at T12. The sham group (n=6) received laminectomy alone. RESULTS: APC significantly reduced the motor disturbances and electrophysiological impairments induced by SCI. APC-treated animals also showed a trend towards a reduction in lesion size. However, this change, was not significant. CONCLUSION: Pre-treatment with APC attenuates the harmful effects of SCI not only during the acute and subacute phases but also in the chronic stage.

Animals↗
PubMed1975

Influence of changes in arterial PCO2 on cerebral blood flow and cerebral energy state during hypothermia in the rat.

In order to study the relationship between arterial PCO2 and cerebral blood flow (CBF) in hypothermia, the body temperature of artifically ventilated rats was decreased to 22 degreesC, and changes in CBF were evaluated from arteriovenous differences in oxygen content (AVDO2) at PaCO2 values of 15, 30, 40 and 60 mm Hg. The results were compared to those obtained at normal body temperature (37 degrees C) over the PaCO2 range 15-60 mm Hg. Separate experiments were performed to evaluate CBF and CMRO2 at 22 degrees C and a PaCO2 of 15 mm Hg, using an inert gas technique for CBF. The tissue contents of phosphocreatine, ATP, ADP, AMP and lactate were measured in hypothermic animals at PaCO2 values of 15, 30 and 60 mm Hg. The results showed that changes in CBF were of the same relative magnitude in hypothermia and normothermia when PaCO2 was increased from about 35 to about 60 mm Hg. However, with a decrease in PaCO2 the reduction in CBF was much more pronounced in hypothermia, and at PaCO2 15 Mm Hg CBF was less then 20% of the value measured in normothermic and normocapnic animals. The results of the metabolite measurements gave no evidence of tissue hypoxia in spite of the pronounced reduction in CBF. Although the results demonstrate that the brain of a hypothermic animal is protected against the harmful effects of a lowered CBF, it may not warrant recommending hyperventilation in clinical cases of hypothermia, especially not in patients with arteriosclerosis or cerebrovascular diseases.

Adenosine Diphosphate↗
PubMed2006

Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi round.

BACKGROUND: To properly balance the benefit (reduction of local recurrence) of short-term pre-operative radiotherapy for resectable rectal cancer against its harm (complications), a consensus concerning the severity of complications is required. The aim of this study was to reach consensus regarding major and minor complications after short-term radiotherapy followed by total mesorectal excision in the treatment of rectal carcinoma, using the Delphi technique. METHODS: A Delphi round was performed in cooperation with 21 colo-rectal surgeons from the Netherlands, United Kingdom and Sweden. The key-question was: 'Which of the predefined complications, caused or substantially aggravated by radiotherapy, are so important (major) that they might lead to the decision to abandon short-term pre-operative radiotherapy (5 x 5Gy) when treating patients with resectable rectal cancer (T1-3N0-2M0)?' RESULTS: After three rounds, consensus was reached for 37 (68%) of 54 complications of which 13 were considered major and 24 considered minor. The following complications were considered to be major: mortality, anastomotic leakage managed by relaparotomy, anastomotic leakage resulting in persisting fistula, postoperative haemorrhage managed by relaparotomy, intra-abdominal abscess without healing tendency, sepsis, pulmonary embolism, myocardial infarction, compartment syndrome of the lower legs, long-term incontinence for solid stool, long-term problems with voiding, pelvic fracture with persisting pain, and neuropathy with persisting pain (legs). Three of 17 complications without consensus showed a tendency to be considered as major: perineal wound dehiscence managed by surgical treatment, small bowel obstruction leading to relaparotomy and long-term incontinence for liquid stool. CONCLUSION: The 13 major and three 'accepted as major' complications can be used to properly balance the benefit and harm of short-term pre-operative radiotherapy in resectable rectal cancer. This may eventually lead to improved treatment strategies for these patients.

Belgium↗