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BACKGROUND: Screening options for pancreatic ductal adenocarcinoma (PDAC) are limited. New-onset type 2 diabetes (NoD) is associated with subsequent diagnosis of PDAC in observational studies and may afford an opportunity for PDAC screening. We evaluated this association using a large administrative database. METHODS: Patients were identified using claims data from the OptumLabs® Data Warehouse. Adult patients with NoD diagnosis were matched 1:3 with patients without NoD using age, sex and chronic obstructive pulmonary disease (COPD) status. The event of PDAC diagnosis was compared between cohorts using the Kaplan-Meier method. Factors associated with PDAC diagnosis were evaluated with Cox's proportional hazards modeling. RESULTS: We identified 640 421 patients with NoD and included 1 921 263 controls. At 3 years, significantly more PDAC events were identified in the NoD group vs control group (579 vs 505; P < 0.001). When controlling for patient factors, NoD was significantly associated with elevated risk of PDAC (HR 3.474, 95% CI 3.082-3.920, P < 0.001). Other factors significantly associated with PDAC diagnosis were increasing age, increasing age among Black patients, and COPD diagnosis (P ≤ 0.05). CONCLUSIONS: NoD was independently associated with subsequent diagnosis of PDAC within 3 years. Future studies should evaluate the feasibility and benefit of PDAC screening in patients with NoD.

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BACKGROUND: Modern advances in genetic sequencing techniques have allowed for increased availability of genetic testing for hereditary cancer syndromes. Consequently, more people are being identified as mutation carriers and becoming aware of their increased risk of malignancy. Testing is commonplace for many inheritable cancer syndromes, and with that comes the knowledge of being a gene carrier for some patients. With increased risk of malignancy, many guidelines recommend that gene carriers partake in risk reduction strategies, including risk-reducing surgery for some syndromes. This review explores the quality-of-life consequences of genetic testing and risk-reducing surgery. METHODS: A narrative review of PubMed/MEDLINE was performed, focusing on the health-related quality-of-life implications of surgery for hereditary breast and ovarian cancer, familial adenomatous polyposis and hereditary diffuse gastric cancer. RESULTS: Risk-reducing surgery almost uniformly decreases cancer anxiety and affects patients' quality of life. CONCLUSION: Although the overwhelming quality-of-life implications of surgery are neutral to positive, risk-reducing surgery is irreversible and can be associated with short- and long-term side-effects.

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The Health and Environmental Sciences Institute (HESI) Developmental and Reproductive Toxicology Technical Committee sponsored a pharmaceutical industry survey on current industry practices for contraception use during clinical trials. The objectives of the survey were to improve our understanding of the current industry practices for contraception requirements in clinical trials, the governance processes set up to promote consistency and/or compliance with contraception requirements, and the effectiveness of current contraception practices in preventing pregnancies during clinical trials. Opportunities for improvements in current practices were also considered. The survey results from 12 pharmaceutical companies identified significant variability among companies with regard to contraception practices and governance during clinical trials. This variability was due primarily to differences in definitions, areas of scientific uncertainty or misunderstanding, and differences in company approaches to enrollment in clinical trials. The survey also revealed that few companies collected data in a manner that would allow a retrospective understanding of the reasons for failure of birth control during clinical trials. In this article, suggestions are made for topics where regulatory guidance or scientific publications could facilitate best practice. These include provisions for a pragmatic definition of women of childbearing potential, guidance on how animal data can influence the requirements for male and female birth control, evidence-based guidance on birth control and pregnancy testing regimes suitable for low- and high-risk situations, plus practical methods to ascertain the risk of drug-drug interactions with hormonal contraceptives.

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Spontaneous pneumomediastinum (SP) unrelated to assisted ventilation is a newly recognised complication of severe acute respiratory syndrome (SARS). The objective of the present study was to examine the incidence, risk factors and the outcomes of SP in a cohort of SARS victims from a community outbreak. Data were retrieved from a prospectively collected database of virologically confirmed SARS patients. One hundred and twelve cases were analysable, with 13 patients developing SP (11.6%) at a mean +/- SD of 19.6 +/- 4.6 days from symptom onset. Peak lactate dehydrogenase level was associated with the development of SP. SP was associated with increased intubation and a trend towards death. Drainage was required in five cases. For patients who survived, the SP and/or the associated pneumothoraces took a median of 28 days (interquartile range: 15-45 days) to resolve completely. In conclusion, spontaneous pneumomediastinum appeared to be a frequent complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis.

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The prone table machine is a mammographic X-ray system specially designed for use in the stereotactic localisation of breast abnormality. In this study, its clinical usefulness was investigated in terms of duration, success rate, complications, and patients' acceptance of the procedure. During a 5-month period, 79 patients attended the Kwong Wah Hospital for stereotactic-guided biopsy on the prone table. Eighty-one lesions were assessed-seven by fine needle aspirations, 67 by large-core needle biopsies, and seven by vacuum-assisted biopsies. Most of the biopsies were done because of clustered microcalcifications (77.8%) and the majority were of mammographically indeterminate nature (58.0%). The mean duration of the procedure was 49 minutes. A high degree of acceptance was experienced by patients. Only one patient had persistent haemorrhage after the biopsy. In conclusion, the prone table machine was considered to be useful and efficient, and had a high degree of acceptance among patients.

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AIM: To determine the size of the problem of premature discharge in a community hospital (CH) and to ascertain the reasons for it. METHOD: A retrospective review of all admissions in year 2000 which resulted in premature discharge i.e. discharge within one week of admission, was conducted in a community hospital, St Luke's Hospital for the Elderly. Information collected on the selected cases included biodata, reason for CH stay, admitting diagnosis, source of admission, duration of stay and reason for terminating stay prematurely. For cases which required acute hospital transfer or ended in death in the CH, the type and day of onset of the respective medical problems were documented. RESULTS: Out of 924 admissions in year 2000, 12% resulted in premature discharge. Within this category of patients, 54% were discharged within the first three days and median duration of stay was three days. Majority of the admissions were for rehabilitation (83%) and respite care (15%). Neurological (60%) and orthopaedic (18%) problems constituted the bulk of the admitting diagnoses. The main reason for premature discharge was acute hospital transfer (90%) for medically unstable patients and those with unresolved medical problems. CONCLUSION: Premature discharge in the CH is an important issue and the greater cause lies in the need to transfer medically unstable patients or patients with unresolved medical problems back to the acute hospital. Stricter enforcement of admission criteria into CHs, increased vigilance on the part of acute hospitals and implementation of subacute care in CH can be solutions to the problem.

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We report the ultrasonographic findings of a 60 year old woman with pseudotumorous form of ascariasis. Real-time ultrasonographic examination using a curved array transducer revealed grossly thickened small bowel loops, multiple small circular deposits throughout the peritoneal cavity, and a moderate amount of ascites. The English literature on the different forms of abdominal ascariasis is reviewed. Specific signs, which include the 'strip' sign, the 'four-lines', 'inner tube', or 'double tube' sign, the 'bull's eye' or 'target' sign, a 'worm mass' or 'spaghetti-like' appearance, and the 'zig-zag' sign can be present in any form of abdominal ascariasis, as they represent the image of the Ascaris worms visualized under ultrasonographic examination. However, the non-specific signs are not peculiar to A. lumbricoides infections, but are results of secondary changes due to A. lumbricoides infections in the corresponding organs.

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A subchronic oral toxicity study of sodium metabisulphite and acetaldehyde hydroxysulphonate was conducted in normal and sulphite oxidase-deficient rats. At the highest dose level (350 mg SO2 equiv./kg body weight/day for 3 wk followed by 175 mg SO2 equiv./kg body weight/day for 5 wk of either compound), gastric lesions were noted histologically in both normal and sulphite oxidase-deficient rats. The lesions were more severe and more frequently encountered in the sulphite oxidase-deficient rats. The no-effect level for Na2S2O5 was 70 mg SO2 equiv./kg body weight/day in both normal and sulphite oxidase-deficient rats. Liver lesions were noted in rats treated with acetaldehyde hydroxysulphonate. These lesions may possibly be attributable to the effects of free acetaldehyde. The no-effect level for acetaldehyde hydroxysulphonate was 7 mg SO2 equiv./kg body weight/day for sulphite oxidase-deficient rats and 70 mg SO2 equiv./kg body weight/day for normal rats. Increased urinary excretion of sulphite was noted in sulphite oxidase-deficient rats whether or not they were given exogenous sulphites. An increase in urinary sulphite levels in sulphite oxidase-deficient rats was observed after dosing with acetaldehyde hydroxy-sulphonate. These findings suggest that acetaldehyde hydroxysulphonate is metabolized to acetaldehyde and free sulphite.

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When [14C]histamine was administered orally to rats, an average of 80% of the administered radioactivity was recovered in the urine at the end of 24 hr. About 10% of the total dose was excreted via the feces. Analysis of 4-hr urine samples found imidazoleacetic acid to be the predominant metabolite (60.6%), with N tau-methylimidazoleacetic acid (8.6%), N tau-methylhistamine (7.3%), and N-acetylhistamine (4.5%) to be the minor metabolites. Histamine metabolism was inhibited by simultaneous oral administration of aminoguanidine, isoniazid, quinacrine, cadaverine, putrescine, tyramine, and beta-phenylethylamine. The administration of inhibitors resulted in an increased amount of unmetabolized histamine and a decreased amount of metabolites reaching the urine. Pharmacologic inhibitors were found to be more potent and have a longer duration of action than foodborne ones. The inhibitors could potentiate food poisoning caused by histamine by inhibiting its metabolism.

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A reversed-phase ion-pair high-performance liquid chromatographic procedure for quantitative determination of histamine and its metabolites in rat urine is described. This method allows simultaneous analysis of five major histamine metabolites. Good separations were obtained by using 1-pentanesulfonic acid as the ion-pair reagent. A gradient elution program was used; the total elution time was less than 22 min. Linear standard curves with high correlation coefficients were obtained. This procedure has the advantage of requiring little sample preparation time and handling, and therefore maximizes the recovery of metabolites.

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A high pressure liquid chromatographic (HPLC) procedure is described for determining the following putrefactive amines: histamine, tyramine, putrescine, cadaverine, tryptamine, and beta-phenylethylamine. The amines were extracted from tuna or cheese with methanol. Further cleanup was performed by sequential extractions with butanol and HCl. The acid extract was dried, and residues were derivatized with dansyl chloride. HPLC separations were performed on an Ultrasphere-ODS column at 33 degrees C. A gradient elution program was used; the total elution time was less than 17 min. Linear standard curves with high correlation coefficients were obtained. The procedure allowed good recoveries of histamine, tyramine, putrescine, and cadaverine; recoveries of tryptamine and beta-phenylethylamine were lower but constant. With this method, some swiss cheese samples were found to contain considerable amounts of histamine, tyramine, putrescine, cadaverine, and beta-phenylethylamine. Canned tuna samples had very low levels of these amines. Since the presence of amines at high levels has been associated with tuna decomposition, this method may be useful in identifying decomposed fish.

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