OBJECTIVES:We evaluated the effect of the use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), and anticoagulants on the performance of immunochemical fecal occult blood test (I-FOBT).METHODS:A prospective, cross-sectional study of 1,221 ambulatory patients having total colonoscopy after preparing three I-FOBTs. Information regarding the use of medications was collected from the health medical organization (HMO) database. I-FOBT was analyzed with the OC-MICRO instrument using both >/=75 and 100 ngHb/ml of buffer thresholds to determine positivity.RESULTS:Colorectal cancer (CRC) was found in 17 and advanced adenomatous polyp (AAP) in 97 patients. A total of 212 patients were using aspirin/NSAIDS at the time of I-FOBT testing. Qualitative analysis for the detection of AAP/CRC reveals a trend for an increased sensitivity with aspirin/NSAIDS use. At the threshold 75 ng/ml for positivity, the sensitivity for the detection of AAP/CRC was 66.7% for aspirin/NSAIDS use vs. 51.2% for nondrug takers (P=0.20), and at the threshold of 100 ng/ml, the sensitivity was 66.7 vs. 46.5%(P=0.09). The specificity, however, was not affected by the use of aspirin/NSAIDS. At the threshold of 75 ng/ml for positivity, the specificity for the detection of AAP/CRC was 89.5% for aspirin/NSAIDS use vs. 91.2% for nondrug takers (P=0.47), and at the threshold of 100 ng/ml, the specificity was 92.17 vs. 93.0%(P=0.69). A total of 33 patients were using antithrombotics/coagulants at the time of I-FOBT testing. This group was small; however, it appears that their use was also associated with a trend for increased sensitivity and no change in specificity.CONCLUSIONS:The use of aspirin/NSAIDS and anticoagulants was associated with a trend for increased sensitivity with no change in specificity for the detection of AAP/CRC. This study suggests that there is no need to stop these agents before I-FOBT testing.Am J Gastroenterol advance online publication, 17 March 2009; doi:10.1038/ajg.2009.14.

BACKGROUND: Mortality from acute coronary syndrome has historically been higher in women as compared with men. We hypothesized that adoption of a more sensitive definition for the diagnosis of acute myocardial infarction and managing patients according to the 2000 European Society of Cardiology and American College of Cardiology guidelines would reduce this difference. METHODS: A retrospective cohort study was conducted of all acute coronary syndrome admissions to 7 regional tertiary hospitals in Israel during 1999-2004. The primary end point was all-cause 1-year mortality. Differences in risk between men and women were assessed using Cox proportional hazards regression. RESULTS: The number of patients admitted with acute coronary syndrome was 20,206 and 15,583 before and after adoption of the guidelines, respectively. An invasive strategy during the index hospitalization was more frequent in men in both the pre-(47.6% vs 33.6, P <.001) and post-(55.7% vs 40.9%, P <.001) transition periods. Secondary prevention was intensified in the post-transition period in both sexes. Multivariate analysis adjusting for differences in baseline clinical characteristics between men and women and invasive strategy demonstrated that female sex was associated with increased 1-year mortality during the pretransition period (hazard ratio 1.34, 95% confidence interval, 1.24-1.45), but was not a significant factor in the post-transition period (hazard ratio 1.04, 95% confidence interval, 0.94-1.14). CONCLUSIONS: The transition to the 2000 European Society of Cardiology and American College of Cardiology guidelines was associated with a reduction in the sex-based mortality difference in patients with acute coronary syndrome despite the fact that an early invasive strategy and secondary prevention continued to be underutilized in female patients in both periods.

OBJECTIVE: To determine the efficacy of 14-Fr PVC round drain in the direct measurement of intra-abdominal pressure. METHODS: Fifty consecutive patients undergoing elective laparoscopic surgery in a tertiary teaching hospital were included in this pilot study. Patients underwent laparoscopic cholecystectomy, appendectomy, splenectomy, colectomy and Nissen fundoplication. After creation of pneumoperitoneum and insertion of the trocars as indicated by the operation, a 14-Fr PVC round drain was inserted into the abdominal cavity via one of the laparoscopic ports. It was then connected under sterile conditions to the invasive blood pressure measurement system. Intra-abdominal pressure was gradually increased. Intra-abdominal pressures as measured through the round PVC drain were compared to those measured by the laparoscopic insufflator at 5, 8, 12 and 24 mmHg. RESULTS: Two hundred measurements using each of the two methods were performed and correlated. The correlation coefficient was 0.996. No complications were observed with this new technique. CONCLUSION: Direct measurement of intra-abdominal pressure using 14-Fr PVC round drain is a newly described technique that is simple, fast and credible. Future investigation will be needed to confirm the reliability of this method during postoperative follow-up of intra-abdominal pressures in selected patients.

OBJECTIVE: The purpose of this study was to determine if a 14-F polyvinyl chloride (PVC) round drain is a reliable tool for direct intra-abdominal pressure measurement. DESIGN: A prospective interventional study. SETTING: Department of Surgery B, intensive care unit, recovery room, Hillel-Yaffe level II trauma center. METHODS: Forty patients undergoing abdominal surgery and treated postoperatively with intraperitoneal drains and intravesical catheters were included in this study. The indication for insertion of intraperitoneal drains and intravesical catheters was strictly medical. The decision of placing urinary bladder catheter and PVC round drain was done by a senior surgeon. Intra-abdominal pressures were measured simultaneously through the intraperitoneal drain and the urinary catheter. Using a sterile technique, the intraperitoneal drain was disconnected from the drainage bulb and connected to an invasive blood pressure monitoring system. Intravesical pressures were measured by inserting 50 mL into the bladder, and then the urinary catheter was connected to an invasive blood monitoring system. Measurements were done twice a day for 3 days or less if earlier removal of either the intraperitoneal drain or urinary catheters were medically indicated. RESULTS: Two hundred twenty-even simultaneous measurements were performed. Pressures as measured through the intraperitoneal drain were found to be significantly correlated to pressures as measured intravesically (r = 0.962). CONCLUSIONS: Direct measurement of the intra-abdominal pressure via a 14-F PVC round drain is a newly described technique. Our method is simple, safe, and credible. Future investigation is needed to confirm the reliability of this method for continuous postoperative measurement of the intra-abdominal pressure in selected patients.

BACKGROUND: Repaglinide, a new insulin secretagogue, is purported to be as effective as sulphonylurea but is less hypoglycemic-prone. OBJECTIVES: To assess the efficacy of repaglinide and its proclivity for hypoglycemia in a post-marketing study. METHODS: The study group comprised 688 patients, aged 26-95 years, clinically diagnosed with non-insulin-dependent type 2 diabetes. The patients were divided into three groups based on previous therapy: a) sulphonylurea-treated (group 1, n = 132); b) metformin with or without sulphonylurea where sulphonylurea was replaced with repaglinide (group 2, n = 302); and c) lifestyle modification alone (drug-naive)(group 3, n = 254). At initiation of the study, all patients were transferred from their current treatment to repaglinide. Only patients in group 2, with combined sulphonylurea plus metformin, continued with metformin plus repaglinide. Fasting blood sugar, hemoglobin A1c and weight were measured at study entry and 4-8 weeks following repaglinide therapy. A questionnaire documented the number of meals daily and the presence of eating from fear of hypoglycemia. RESULTS: The fasting blood sugar level of the entire cohort dropped from 191 +/- 2.4 to 155 +/- 2.0 mg/dl (P < 0.0001); HbA1c from 8.8 +/- 0.1 to 7.7 +/- 0.1%(P < 0.0001). The drop of HbA1c in groups 1, 2 and 3 respectively were: 1.04 +/- 0.22%(P < 0.0001), 1.14 +/- 0.24%(P < 0.0001), and 1.51 +/- 0.31%(P = 0.0137). Weight dropped from 81 +/- 0.7 to 80.2 +/- 0.7 kg (P < 0.0001), and eating from fear of hypoglycemia from 157 to 97 (P < 0.001). The daily number of meals decreased from 2.9 +/- 0.4 to 2.4 +/- 0.4 (P < 0.001). No serious adverse reactions occurred during the study. CONCLUSIONS: Repaglinide is an effective oral hypoglycemic agent taken either as monotherapy or combination therapy. There is less eating to avoid hypoglycemia, fewer meals consumed, and weight loss.

PURPOSE: This study reviews the authors' experience in treating severe pediatric liver injuries with absorbable mesh wrapping. The authors found this relatively new therapeutic method very useful in selected cases, although its use is not very common in children. The authors analyze the indication describe some technical aspects, and discuss the advantages and the pitfalls of the method. METHODS: In a 10-year period between 1990 and 2000, 181 children were admitted to Hillel-Yaffe Medical Center with blunt hepatic trauma. A total of 132 children were treated conservatively, and 49 (27%) were operated on. The operated group included 35 cases of isolated liver injuries and 14 cases of additional intraabdominal injuries. Thirty-four children were operated on between 1990 and 1995 (36% of 96 children), whereas between 1995 and 2000, 15 children were operated on (17% of 85 children), including 4 children aged 18 months to 15 years with massive liver bleeding who were treated with mesh wrap technique. The retrospective analysis of these 4 cases indicates a progressive policy in the recognition of cases suitable for mesh wrapping and gallbladder conservation. RESULTS: The perihepatic mesh wrap technique controlled the bleeding in all children. In 3 of them the right lobe was wrapped, and, in 1 case, total liver wrapping was performed. Hepatic enzymes and bilirubin levels were elevated in the first 3 to 7 days and declined gradually to normal levels. The perihepatic mesh was not an obstacle to a transcutaneous drainage of an intrahepatic biloma. All 4 children returned to normal physical activities. CONCLUSIONS: Liver mesh wrap is a simple, effective, and rapid way to obtain hemostasis and to conserve parenchyma in severe traumatized liver. The decision to wrap the liver should be done early to prevent acidosis and hypothermia. Cholecystectomy is not an integral part of the procedure in children. The morbidity is low, and most of the complications can be treated nonsurgically.

Interactions of natural killer (NK) cells with MHC class I proteins provide the main inhibitory signals controlling NK killing activity. It is therefore surprising to learn that TAP2-deficient patients suffer from autoimmune manifestations only occasionally in later stages of life. We have previously described that the CEACAM1-mediated inhibitory mechanism of NK cytotoxicity plays a major role in controlling NK autoreactivity in three newly identified TAP2-deficient siblings. This novel mechanism probably compensates for the lack of MHC class I-mediated inhibition. The CEACAM1 protein can also be present in a soluble form and the biological function of the soluble form of CEACAM1 with regard to NK cells has not been investigated. Here we show that the homophilic CEACAM1 interactions are abrogated in the presence of soluble CEACAM1 protein in a dose-dependent manner. Importantly, the amounts of soluble CEACAM1 protein detected in sera derived from the TAP2-deficient patients were dramatically reduced as compared to healthy controls. This dramatic reduction does not depend on the membrane-bound metalloproteinase activity. Thus, the expression of CEACAM1 and the absence of soluble CEACAM1 observed in the TAP2-deficient patients practically maximize the inhibitory effect and probably help to minimize autoimmunity in these patients.

The destruction of viral-infected and tumor cells is mediated in part via the lysis receptor of natural killer (NK) cells, NKp46. The nature, however, of its lysis ligands expressed on target cells is poorly defined. Recently, we have identified a novel functional interaction between the lysis receptors NKp46 and NKp44 and the hemagglutinin of influenza and hemgglutininneuroaminidase of Sendai viruses. This recognition depends on the sialylation of NKp46 and NKp44 receptors. In this study, we expand the significance of these observations by demonstrating a conserved pattern of NKp46 and NKp44 recognition by various hemagglutinins derived from different viral strains. We further establish that this recognition is direct and mainly mediated via alpha2,6-linked sialic acid carried by NKp46. In addition, we demonstrate that the ability of NKp46 to recognize target cells is confined to the membrane proximal domain, and largely relies on the highly conserved sugar-carrying residue, Thr 225. This residue plays a critical dual role in NKp46 interactions with both viral hemagglutinins and the unknown tumor ligands via different mechanisms. These results may explain the ability of NK cells to kill such a broad spectrum of viral-infected and tumor cells.