tbuckley/cabot-search huggingface dataset:
PWE-315 Superfluous IV fluids increase complication rate in laparoscopic colorectal surgery
Authors: E Tweedle, J Whiteley, F McNicol, PS Rooney
Journal: Gut (2015)

<h3>Introduction</h3> Our hospital has an established ERAS protocol for colorectal patients. We aimed to assess whether Oesophageal Doppler (OD) and thoracic epidural affected length of stay (LOS) or complications rates. <h3>Method</h3> We analysed a prospectively-collected database of patients undergoing colorectal surgery from 25/11/11 to 14/08/13. There were 231 patients; 121 M: 110 F with a median age of 62 yrs (range 18–92). LOS was typically left-skewed and was transformed using log. Ordinal Least Squares regression was conducted with log[LOS] as the dependant variable. Logistic regression was used to identify factors associated with complications. Variables were analysed separately; those with an association at P &lt; 0.10 were combined in a multivariate analysis in a forward stepwise approach. <h3>Results</h3> Our ERAS protocol routinely utilised 11 constituents of the ERAS compliance group guidelines. Epidural and IV fluid use were under investigation. The median no of ERAS elements per patient was 9 (IQR 7–10). Patients were dichotomised into ERAS compliant (≥9) 143/231 (62%) or ERAS non-compliant (&lt;9) 88/231 (38%). Resections were classified as colonic 105/231 (45%), rectal/combined 83/231 (36%) or none 43/231 (19%). Approach was laparoscopic in 95/231 (41%) cases; conversion rate 21% (20/95). OD was utilised in 117/231 (51%) cases and was associated with a mean rise in IV fluid given of 702ml (P = 0.004, t-test). Thoracic epidural was placed in 37/231 (16%) patients. Overall complication rate was 94/231 (41%); surgical complications were seen in 32%, renal 9%, respiratory 8% and cardiac 4%. Multivariate analysis independently linked increased LOS with surgical complications (P &lt; 0.0001), renal complications (P = 0.0001), longer operating times (P = 0.0047), creation of stoma (P = 0.0259) and non-compliance with ERAS protocol (P = 0.056). ERAS compliance did not significantly affect LOS in the laparoscopic cohort, whereas in the open group this retained significance (P = 0.0107). Development of any complication was associated with ASA grade of &gt;2 (P = 0.001), use of IV opiates &gt;48 hrs (P = 0.0120) and rectal surgery (P = 0.0879). In the laparoscopic cohort, only higher intra-op fluid volume (P = 0.0444) and IV opiates (P = 0.0169) correlated with complication rate. In this cohort, fluid volume predicted complications in the non-OD group (n = 41; P = 0.0253), but not the OD group (n = 52, P = 0.8863). <h3>Conclusion</h3> Compliance with the ERAS protocol reduced LOS in patients having open surgery. Boosting outpatient support for patients with new stomas may reduce LOS. OD and epidural were not correlated with LOS. In the laparoscopic cohort, higher complication rates were seen with use of IV opiates &gt;48 hrs and greater volumes of fluid intra-op. IN this group of patients, OD may safely identify patients who require fluid resuscitation whilst avoiding overload. <h3>Disclosure of interest</h3> None Declared.
PTU-201 Living with anal fistulae
Authors: NA Yassin, L Dibley, S Nachiappan, R Phillips, A Hart, C Norton
Journal: Gut (2015)

<h3>Introduction</h3> Around one in 10,000 people develop an idiopathic anal fistula and one third of patients with Crohn’s disease (CD) develop perianal fistulae. The associated morbidity of anal fistulae and its treatments can have profound effects on patients. The inflammatory bowel disease questionnaire (IBD-Q) has been used to assess the quality of life (QoL) of Crohn’s fistula patients on anti-TNF therapy. The Perianal Disease Activity Index (PDAI) has been used for the assessment of Crohn’s anal fistulae, although it mostly covers clinical aspects of the disease. Neither the IBD-Q nor the PDAI explore issues relating specifically to perianal fistulae. There are no specific idiopathic anal fistula QoL assessment tools. The aim of this study was to gain an understanding of the experience of perianal fistulae for Crohn’s and idiopathic fistula patients. <h3>Method</h3> Crohn’s and idiopathic fistula patients were identified from outpatient clinics, and invited to participate after reading the patient information sheets. Semi-structured interviews were conducted on 25 consenting fistula patients (20 Crohn’s, 5 idiopathic). Interviews were transcribed verbatim, and transcripts analysed independently by two researchers using a thematic analysis approach as guided by Colaizzi’s framework. Themes were identified relating to the experience of living with anal fistulae. <h3>Results</h3> Nine central themes were identified: diagnosis and acceptance (relief at getting a diagnosis which was explained to them), decision making (patients involvement in their treatment plan), coping strategies (having people around to provide support, or stocks of medical supplies in case of flares), body image (affecting patients’ self-esteem), stigma (including self- and perceived-stigma), relationships (detailing the difference between intimacy and companionship), social implications (including daily living activities and holidays), education and work (and the requirements for life adjustments) and clinical care issues such as having information regarding medical and surgical issues. Each of these main themes was divided into several subthemes. <h3>Conclusion</h3> Crohn’s and idiopathic anal fistulae are a major cause of distress and greatly impact on patients’ lives. The study findings have revealed new insights into specific issues related to living with perianal fistulae. These issues may lead to emotional, social, work-related and financial restrictions, which should be appreciated by health care professionals. There is a need for further research in this area to improve our understanding of the impact of anal fistulae on patients’ QoL and develop appropriate assessment tools designed specifically for this group of patients. <h3>Disclosure of interest</h3> None Declared.
Switching To Nilotinib In Patients (pts) With Chronic Myeloid Leukemia In Chronic Phase (CML-CP) With Suboptimal Cytogenetic Response (CyR) On Imatinib: First Results Of The LASOR Trial
Authors: Jorge E. Cortes, Carmino Antonio De Souza, Jose Luis Lopez, Manuel Ayala, Eduardo Bullorsky, Xiaojun Huang, Sandip Shah, K. Govind Babu, Tomasz Sacha, Israel Bendit, Zhizhou Liang, Tina Owugah, Prasanna Kumar Nidamarthy, Tomasz Szczudlo, Carmen Piccolo, Philipp D. le Coutre
Journal: Blood (2013)
Differential memory complaints after bilateral and unilateral ECT
Authors: J Rosenberg, H M Pettinati
Journal: American Journal of Psychiatry (1984)

A structured interview was used to elicit 35 depressed patients' reports of memory function after a full course of either bilateral or unilateral ECT. The interviewer and patients were blind to the type of electrode placement. Although the two groups of subjects did not differ in severity of depression or amount of ECT, significantly more patients receiving bilateral ECT reported general difficulty remembering things, difficulty describing events before hospitalization, and difficulty remembering daily events.
THU0163 TNF-related Apoptosis-inducing Ligand and Cardiovascular Disease in Rheumatoid Arthritis
Authors: P.H. Dessein, R. Lopez-Mejias, B. Ubilla, F. Genre, A. Corrales, J.L. Hernandez, I. Ferraz-Amaro, L. Tsang, T. Pina, J. Llorca, R. Blanco, C. Gonzalez-Juanatey, M.A. Gonzalez-Gay
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Whether TNF-related apoptosis-inducing ligand (TRAIL) impacts cardiovascular risk in rheumatoid arthritis (RA) is currently unknown. <h3>Objectives</h3> We examined the association of TRAIL concentrations with cardiovascular disease (CVD) in RA and, since osteoprotegerin (OPG) can act as a decoy receptor for TRAIL, whether TRAIL concentrations impact on the independent OPG level-atherosclerotic CVD relation that was recently documented in the present cohort (1). <h3>Methods</h3> TRAIL concentrations were assessed by ELISA in 151 RA patients of which 75 (49.7%) had CVD comprising ischemic heart disease (n=27), cerebrovascular accident (n=26), peripheral artery disease (n=9) or/and heart failure (HF) (n=27), and 62 controls. <h3>Results</h3> Mean RA duration was 12 years. In RA patients, C-reactive protein (CRP) levels and cholesterol-HDL cholesterol ratio related to TRAIL concentrations [partial R (p) = -0.222 (0.006) and 0.174 (p=0.04), respectively]. TRAIL concentrations were smaller in RA patients compared to controls (median (interquartile range) =80.2 (60.9-120.4) versus 130.4 (89.4-167.7) pg/ml, p&lt;0.0001)). TRAIL levels were larger in RA patients with compared to those without HF (105.5 (66.5-143.4) versus 79.9 (57.8-110.6), p=0.02); this difference was independent of demographic characteristics and traditional cardiovascular risk factors (p=0.04) but not CRP concentrations (p=0.1). TRAIL levels were consistently unrelated to atherosclerotic CVD. Our previously reported OPG-atherosclerotic CVD relation in RA survived adjustment for TRAIL concentrations in a mixed regression model (p=0.04). <h3>Conclusions</h3> TRAIL concentrations are markedly reduced and associated with HF in established RA, this relationship being explained by CRP levels. OPG may directly enhance CVD risk in RA (1). <h3>References</h3> Lopez-Mejias, Ubilla B, Genre F, Corrales A, Hernandez JL, Ferraz-Amaro I, Tsang L, Llorca J, Blanco R, Gonzalez-Juanatey C, Gonzalez-Gay MA, Dessein PH. Osteoprotegerin concentrations relate independently to established cardiovascular disease in rheumatoid arthritis. J Rheumatol 2015;42:39-45. <h3>Disclosure of Interest</h3> None declared
AB0622 Risk Factors for Organ Damage in Patients with Systemic Lupus Erythematosus
Authors: V. Zivkovic, B. Mitic, T. Cvetkovic, B. Stamenkovic, J. Nedovic, S. Milenkovic, I. Aleksic
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Adequate assessment of disease activity in patients with systemic lupus erythematosus (SLE) using disease activity index, evaluating the extent of organ damage and quality of life, contributes to better monitoring, treatment, and improved prognosis in SLE patients. Organ damage element of the index in SLE patients predicts further organ damage and is associated with increased risk of mortality. <h3>Objectives</h3> Our aim was to examine the correlation between organ damage and disease activity, quality of life, and severity of fatigue. Risk factors for organ damage in SLE patients were established. <h3>Methods</h3> The study enrolled 83 SLE patients with disease duration of over 6 months, hospitalized at the Institute "Niška Banja" in 2012, out of which 6 men (7.2%) and 77 women (92.8%), aged 45.8±9.2 years on the average, with average disease duration of 10.6±7.9 years. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and physician9s global assessment, and degree of damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for SLE (SLICC/ACR Damage Index - SDI). Quality of life was assessed based on the standardized Medical Outcome Survey Short Form 36 (SF-36), and severity of fatigue using the Fatigue Severity Scale. <h3>Results</h3> Average SDI value was 1.8±1.9 (median 1, min. 0, max. 9), and average SLEDAI was 10.9±7.4. Our results demonstrated that SDI was positively correlated with SLEDAI, global physician9s assessment, and severity of fatigue (r=0.359, p=0.001; r=0.357, p=0.001; r=0.296, p=0.007, respectively), being associated as well with poorer quality of life. Univariant analysis demonstrated that age, disease duration (especially if over 10 years- OR 3.368, CI95% 1.01-11.34, p=0.045), high disease activity at global physician9s assessment, as well as the use of Azathioprine, were all independent risk factors for organ damage. Use of Chloroquine was an important protective factor regarding organ damage (OR 0.378, CI95% 0.14-0.99, p=0.048). Our results demonstrated that the levels of anti-dsDNA antibodies, anti-nucleosome, anti-C1q antibodies, as well as the level of monocyte chemoattractant protein-1 in the serum and urin, were not predictors of organ damage. Multivariant logistic regression showed that high disease activity at global physician9s assessment (OR 31.839, 95CI% 2.33-435.58, p=0.01) and use of Azathioprine (OR 7.256, 95CI% 1.37-5.63, p=0.005) were the strongest predictors of organ damage. <h3>Conclusions</h3> Organ damage in SLE patients increases with advancing age and disease duration. The strongest predictors of organ damage are high disease activity at global physician9s assessment and use of cytostatic agents. Use of Chloroquine can afford some protection against organ damage. <h3>Disclosure of Interest</h3> None declared
PTH-034 Hemospray may not reliably achieve hemostasis beyond 48 hours in acute upper gastrointestinal bleeding
Authors: S Dixon, D Tate, R Przemioslo, M Lockett
Journal: Gut (2015)

<h3>Introduction</h3> Hemospray (Cook labs, Birmingham, USA) has been shown in multiple case series to be a useful and effective tool<sup>1</sup>in the management of acute GI bleeding where existing therapies fail to achieve hemostasis<sup>2</sup>or are impractical. It is as yet unclear whether treatment with Hemospray provides temporary or definitive benefit. <h3>Method</h3> We prospectively followed 9 consecutive cases in which Hemospray was used to control acute upper GI bleeding. Each case was followed to 30 days at which point the primary end-points of rebleeding and mortality were documented. Data was sourced from case notes and the local endoscopy database. All patients were treated at Southmead Hospital, Bristol, United Kingdom – a large endoscopy unit serving a population of around 620,000. Statistical analysis was by chi-squared and unpaired t-test. <h3>Results</h3> 9 patients (7 males, 2 females) were included in the study with a mean age of 60.1 years (range 18–86 years). Endoscopic diagnoses included duodenal ulcer (3), gastric ulcer (1), gastric tumour (1), oeosophageal varices (1), Dieulafoy lesion (1), ERCP sphincterotomy site bleed (1) and angiodysplasia (1). Hemospray was used as the only therapeutic modality in 7 cases. Hemostasis was achieved in 6/9 cases at the index endoscopy. In 3/9 cases bleeding continued: 2 patients underwent further endotherapy and 1 patient required a Sengstaken-Blakemore tube and subsequently died. 3/9 patients experienced rebleeding. 1 patient required further endotherapy and 2 patients required laparotomy. 2 patients experienced rebleeding more than 48 h after the index endoscopy. Rebleeding did not vary across the range of endoscopic diagnoses (p = 0.423) or age of patient (p = 0.302). At 30 days only 3/9 patients treated with Hemospray did not require further intervention. 8/9 patients survived to 30 days. <h3>Conclusion</h3> Our case series indicates that apparent initial hemostasis after application of Hemospray may be a temporary outcome only. In the UK, where physicians are urged to discharge patients soon after clinical stability has been achieved, this is a particularly important message. There may be benefit from relook endoscopy at 48 h or prolonged inpatient observation although this has not been suggested elsewhere. Larger studies are required and a region-wide series is planned. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Bustamante-Balén M, Plumé G. Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding. <i>World J Gastrointest Pathophysiol</i>. 2014;5(3):284–92 Smith LA, Morris AJ, Stanley AJ. The use of hemospray in portal hypertensive bleeding; a case series. <i>J Hepatol</i>. 2014 Feb;60(2):457–60
Unusual Cell Junctional Complexes in Canine Mammary Adenoacanthomas 2
Authors: Joseph Alroy, Ronald S. Weinstein
Journal: JNCI Journal of the National Cancer Institute (1976)

Journal Article Unusual Cell Junctional Complexes in Canine Mammary Adenoacanthomas Get access Joseph Alroy, D.V.M., Joseph Alroy, D.V.M. 3Department of Pathology, Angell Memorial Hospital, Boston, Mass. 02111. 4Present address: Department of Pathology, Rush Medical School, Chicago, Ill. 60612 Search for other works by this author on: Oxford Academic PubMed Google Scholar Ronald S. Weinstein, M.D. Ronald S. Weinstein, M.D. 4Present address: Department of Pathology, Rush Medical School, Chicago, Ill. 60612 5Department of Pathology, Rush Medical School. 6We thank Mrs. Marjorie DeVeau and Mrs. William Leonard for their technical assistance. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 56, Issue 3, March 1976, Pages 667–670, https://doi.org/10.1093/jnci/56.3.667 Published: 01 March 1976 Article history Received: 07 August 1975 Accepted: 14 October 1975 Published: 01 March 1976
PWE-231 Split stomas, intestinal failure and outcomes after emergency laparotomy
Authors: R Kalaiselvan, C Tamura, D Smith, CJ Walsh
Journal: Gut (2015)

<h3>Introduction</h3> Intestinal anastomoses are regarded as high risk in the context of emergency laparotomy (EL) for abdominal catastrophe in critically ill patients. Resection and split stoma formation may be a better option yet surgeons may be intimidated by formation of proximal stomas and the associated Intestinal Failure (IF) that ensues. We have audited our outcomes of emergency bowel resection with split stomas (SS) and their reversal. <h3>Method</h3> Retrospective study of consecutive patients who underwent EL and formation of SS from July 2010 to April 2014. Outcome analysis was done from prospectively maintained nutrition team database and cross-referenced with case notes. Data are represented as median (range). Emergency non-split stomas excluded. <h3>Results</h3> 27 patients (13 men; age 68(36–90)years) underwent EL following <i>de novo</i>acute intra-abdominal catastrophe (n = 24) or as a post-operative complication following elective surgery (n = 3). Aetiology was acute mesenteric ischaemia (n = 13), intestinal obstruction (n = 8), peritionitis due to perforation (n = 3) and post-operative complications (peritonitis, n = 3). Median ASA was 3(1–4). The length of hospital stay was a median of 92(29–218) days. 3 patients died at 28, 29 and 87 days following resuscitative laparotomy yielding a 30-day mortality of 6.3%(n = 2) and 90 day mortality of 9.3%(n = 3). All patients required parenteral nutrition (PN). PN was delivered by peripherally inserted central catheter in all patients. Median duration of PN was 94(26–322) days. 2 patients achieved nutritional autonomy and elected to live with their stoma. 22(81%) of the original 27 patients underwent stoma reversal at a median of 3.7(1.6–14.3) months following the initial insult. 17 patients required in-patient PN because of problematic high output. After reversal of their stomas they became nutritionally independent. The remaining 5 patients required PN for 74(30–137) days after the EL and were nutritionally optimised on oral diet on discharge. These 5 patients returned electively for successful stoma reversal. There were no anastomotic or intra abdominal septic complications. There was 1(3.8%) post op death after stoma reversal (myocardial infarction). No patient developed Type 3 IF. Survival following EL at 1 year and 3 years was 81% and 70% respectively. Survival following reversal of stoma (n = 22) at 1 year and 4 years was 95% and 73% at a median follow-up of 25(5–39) months. Comparison of overall survival was not significantly different when comparing age range 36–69 yrs (n = 12, 1yr -83%, 4yrs – 75%) and age range 70–90 yrs (n = 15, 1yr – 80%, 4 yrs 60%) (P = 0.4 - Fisher’s exact test). <h3>Conclusion</h3> Split stomas are a viable option in these high-risk patients. Good survival and nutritional outcomes are achievable, however this approach requires confidence in proximal stoma and safe PN management of Type II IF patients. <h3>Disclosure of interest</h3> None Declared.
THU0250 Changes in the Efficiency of Infectious Spondylodiscitis Bacteriological Testing in the Last Twenty Years
Authors: J. Lopez, Z. Tatar, S. Mathieu, A. Tournadre, M. Couderc, M. Soubrier, J.J. Dubost
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Diagnosing infectious spondylodiscitis is greatly facilitated by improved access to MRI testing. However, MRI testing increases the possibility of false positives. The efficiency of bacteriological testing is highly variable depending on the series performed, and this efficiency is not improving. <h3>Objectives</h3> The objective of this study is to evaluate the efficiency of such testing in the last decade and to compare it with the efficiency determined in the preceding decade by the same department. <h3>Methods</h3> This is a retrospective monocentre study of records of patients hospitalised in the rheumatology department of the CHU de Clermont Ferrand university hospital from 2003 to 2012 for infectious spondylodiscitis. These patients were compared with a historical cohort of 90 patients from the department, including all spondylodiscitis cases from 1992 to 2002 selected using the same criteria. <h3>Results</h3> From 2003 to 2013, 99 patients were hospitalised for infectious spondylodiscitis and were compared with the cohort of 90 patients hospitalised from 1992 to 2002. A pathogen was identified in 78% (77/99) of the cases, which is not significantly different from the preceding decade: 68% (61/90). Blood cultures were positive respectively in 37% (37/99, 37/95 excluding tuberculosis) and 39% (35/90, 35/88 excluding tuberculosis) (NS). In the last decade, pathogens were more often isolated through fine needle aspiration biopsy (FNAB) of the vertebral disc: 47/99 (47%) vs. 28/90 (31%) p=0.02. In the last decade, the efficiency of vertebral disc FNAB was 66% (47/71); eight patients underwent two vertebral disc FNAB and the second biopsy was only positive once. The efficiency was 77% (72/93) for primitive non-tubercular spondylodiscitis in the last decade. Over both periods, the proportion of staphylococci (49%), streptococci and enterococci (23% and 26%), gram negative bacilli (13 and 20%) and tuberculosis (5 and 3%) were not significantly different. However, amongst staphylococci, there was an observed decrease in the proportion of <i>S. aureus</i> in the last decade (47% vs. 70%, p=0.03) and increase in the proportion of coagulase negative staphylococci. Patients of the last decade were older (66 vs. 61 years of age; p=0.01) and more often had infection risk factors (51% vs. 33%; p=0.03), and diabetes in particular (27% vs. 9%; p=0.001). <h3>Conclusions</h3> In our recruitment, the efficiency of bacteriological testing for spondylodiscitis has not declined in 20 years, and has even slightly improved. However, for one quarter of spondylodiscitis cases presumed to be infectious, the pathogen remains unknown. <h3>Disclosure of Interest</h3> None declared