Prognostic Factors Associated with Survival in Patients with Primary Duodenal Adenocarcinoma

Background/Aims: The prognostic factors in primary duodenal adenocarcinoma remain controversial. This study evaluated the prognostic factors associated with survival in patients with primary duodenal adenocarcinoma. Methods: From March 1996 to June 2008, the medical records of 30 patients with a final diagnosis of primary duodenal epithelial malignancy seen at two referral centers were reviewed retrospectively. The prognostic factors for survival were evaluated 6 months and 1, 2, and 5 years after the diagnosis. Results: The median survival was 5.7 months. The survival rate was 46.7 % (14/30), 16.7 % (5/30), 10 % (3/30), and 6.7 % (2/30) at 6 months and 1, 2, and 5 years, respectively. Multivariate analysis showed that cancer-direct-ed treatment, including curative surgery or chemotherapy, was a common independent risk factor at all follow-up times. Total bilirubin, cytology, and TNM stage were independent risk factors for survival at 1, 2, and 5 years. The white blood cell count was an independent risk factor at 1 year only. The actuarial probability of survival in patients undergoing cancer-directed treatment was significantly higher than in those without treatment at 6 months (71.4 vs. 25.0%, p < 0.01), 1 year (28.6 vs. 6.3%, p < 0.01), 2 years (21.4 vs. 0%, p < 0.01), and 5 years (14.3 vs. 0%, p < 0.01). Conclusions: The prognostic factors in patients with primary duodenal adenocarcinoma were total bilirubin, TNM stage, cytology, and cancer-directed treatments until the 5-year follow-up. Especially, cancer-directed treat-ments improved patient survival. (Korean J Intern Med 2011;26:34-40

Endoscopic treatment of prepatellar bursitis

Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21–55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory

Exome sequencing of Finnish isolates enhances rare-variant association power

Exome-sequencing studies have generally been underpowered to identify deleterious alleles with a large effect on complex traits as such alleles are mostly rare. Because the population of northern and eastern Finland has expanded considerably and in isolation following a series of bottlenecks, individuals of these populations have numerous deleterious alleles at a relatively high frequency. Here, using exome sequencing of nearly 20,000 individuals from these regions, we investigate the role of rare coding variants in clinically relevant quantitative cardiometabolic traits. Exome-wide association studies for 64 quantitative traits identified 26 newly associated deleterious alleles. Of these 26 alleles, 19 are either unique to or more than 20 times more frequent in Finnish individuals than in other Europeans and show geographical clustering comparable to Mendelian disease mutations that are characteristic of the Finnish population. We estimate that sequencing studies of populations without this unique history would require hundreds of thousands to millions of participants to achieve comparable association power

Reliability and acceptability of measuring sniff nasal inspiratory pressure (SNIP) and peak inspiratory flow (PIF) to assess respiratory muscle strength in older adults: a preliminary study

Background: sniff nasal inspiratory pressure (SNIP) and peak oral inspiratory flow (PIF) are portable, relatively new methods for indirect measurement of respiratory muscle strength. The reliability and acceptability of these measures were investigated in older adults.Methods: twenty one self-reported healthy adults, aged 65-84 years (Mean 73.5; SD 6.4 years). Participants were tested in a sitting position on two occasions, one week apart. The best of three attempts for PIF measured through the mouth, and five for each nostril for SNIP were recorded. Reliability was tested using intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and Bland and Altman analysis. Feedback on the measures in relation to ease of completion and preference was obtained using a semi-structured interview. Results: between-day reliability of SNIP and PIF were ICC3,1 0.76 (95% CI 0.49-0.9) and 0.92 (0.81-0.97) respectively. Standard error of measurement for SNIP (11.94 cmH2O) and MDC (33.10 cmH2O) were at the least 61% higher than for PIF. The participants reported difficulties in performing SNIP, rating it as being less easy and uncomfortable to perform than PIF, with a higher rate of missing data for SNIP due to participants’ dislike of test. Conclusions: the wide range of SNIP readings, lower ICC value and negative user feedback is suggestive of a less robust and unacceptable clinical measure. PIF showed excellent reliability and acceptability and is therefore recommended for assessing inspiratory muscle strength in older people without known obstructive lung disease<br/