Publications by authors named "David Mansouri"

18 Publications

  • Page 1 of 1

The inflammatory microenvironment in screen-detected premaligant adenomatous polyps: early results from the integrated technologies for improved polyp surveillance (INCISE) project.

Eur J Gastroenterol Hepatol 2021 07;33(7):983-989

Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary.

Introduction: Around 40% of patients who attend colonoscopy following a positive stool screening test have adenomatous polyps. Identifying which patients have a higher propensity for malignant transformation is currently poorly understood. The aim of the present study was to assess whether the type and intensity of inflammatory infiltrate differ between screen-detected adenomas with high-grade dysplasia (HGD) and low-grade dysplasia (LGD).

Methods: A representative sample of 207 polyps from 134 individuals were included from a database of all patients with adenomas detected through the first round of the Scottish Bowel Screening Programme in NHS Greater Glasgow and Clyde (April 2009-April 2011). Inflammatory cell phenotype infiltrate was assessed by immunohistochemistry for CD3+, CD8+, CD45+ and CD68+ in a semi-quantitative manner at 20× resolution. Immune-cell infiltrate was graded as absent, weak, moderate or strong. Patient and polyp characteristics and inflammatory infiltrate were then compared between HGD and LGD polyps.

Results: CD3+ infiltrate was significantly higher in HGD polyps compared to LGD polyps (74 vs. 69%; P < 0.05). CD8+ infiltrate was significantly higher in HGD polyps compared to LGD polyps (36 vs. 13%; P < 0.001) whereas CD45+ infiltrate was not significantly different (69 vs. 64%; P = 0.401). There was no significant difference in CD68+ infiltrate (P = 0.540) or total inflammatory cell infiltrate (calculated from CD3+ and CD68+) (P = 0.226).

Conclusions: This study reports an increase in CD3+ and CD8+ infiltrate in HGD colonic adenomas when compared to LGD adenomas. It may therefore have a use in the prognostic stratification and treatment of dysplastic polyps.
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http://dx.doi.org/10.1097/MEG.0000000000002202DOI Listing
July 2021

The Relationship Between Co-morbidity, Screen-Detection and Outcome in Patients Undergoing Resection for Colorectal Cancer.

World J Surg 2021 07 27;45(7):2251-2260. Epub 2021 Mar 27.

Academic Unit of Surgery, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow, G31 2ER, UK.

Background: Bowel cancer screening increases early stage disease detection and reduces cancer-specific mortality. We assessed the relationship between co-morbidity, screen-detection and survival in colorectal cancer.

Methods: A retrospective, observational cohort study compared screen-detected (SD) and non-screen-detected (NSD) patients undergoing potentially curative resection (April 2009-March 2011). Co-morbidity was quantified using ASA, Lee and Charlson Indices. Systemic inflammatory response was measured using the neutrophil lymphocyte ratio (NLR). Covariables were compared using crosstabulation and the χ2 test for linear trend. Survival was analysed using Cox Regression.

Results: Of 770 patients, 331 had SD- and 439 NSD-disease. A lower proportion of SD patients had a high ASA (≥3) compared to NSD (27.2% vs 37.3%; p = 0.007). There was no significant difference in the proportion of patients with a high (≥2) Lee Index (16.3% SD vs 21.9% NSD; p = 0.054) or high (≥3) Charlson Index (22.7% SD vs 26.9% NSD; p = 0.181). On univariate analysis, NSD (HR 2.182 (1.594-2.989;p < 0.001)), emergency presentation (HR 3.390 (2.401-4.788; p < 0.001)), advanced UICC-TNM (III or IV) (p < 0.001), high ASA (≥3) (HR 1.857 (1.362-2.532; p < 0.001)), high Charlson Index (≥3) (HR 1.800 (1.333-2.432; p < 0.001)) and high (≥3) NLR (HR 1.825 (1.363-2.442; p < 0.001)) were associated with poorer overall survival (OS). NSD predicted poorer cancer-specific survival (CSS) (HR 2.763 (1.776-4.298; p < 0.001)). On multivariate analysis, NSD retained significance as an independent predictor of poorer OS (HR 1.796 (1.224-2.635; p = 0.003)) and CSS (HR 1.924 (1.193-3.102; p = 0.007)).

Conclusions: Patients with SD cancers have significantly lower ASA scores. After adjusting for ASA, co-morbidity and a broad range of covariables, SD patients retain significantly better OS and CSS.
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http://dx.doi.org/10.1007/s00268-021-06079-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154830PMC
July 2021

The prognostic value of combined measures of the systemic inflammatory response in patients with colon cancer: an analysis of 1700 patients.

Br J Cancer 2021 May 24;124(11):1828-1835. Epub 2021 Mar 24.

Academic Unit of Surgery-Glasgow Royal Infirmary, Glasgow, UK.

Background: The pre-operative systemic inflammatory response (SIR) measured using an acute-phase-protein-based score (modified Glasgow Prognostic Score (mGPS)) or the differential white cell count (neutrophil-lymphocyte ratio (NLR)) demonstrates prognostic significance following curative resection of colon cancer. We investigate the complementary use of both measures to better stratify outcomes.

Methods: The effect on survival of mGPS and NLR was examined using uni/multivariate analysis (UVA/MVA) in patients undergoing curative surgery for colon cancer. The synergistic effect of these scores in predicting OS/CSS was examined using a Systemic Inflammatory Grade (SIG).

Results: One thousand seven hundred and eight patients with TNM-I-III colon cancer were included. On MVA both mGPS and NLR were significant for OS (HR 1.16/1.21, respectively). Three-year survival stratified by mGPS was 83-58%(TNM-I-III), 87-65%(TNM-II) and 75-49%(TNM-III), and by NLR was 84-62%(TNM-I-III), 88-69%(TNM-II) and 77-49%(TNM-III). When mGPS and NLR were combined to form an overall SIG 0/1/2/3/4, this stratified 3-year OS 88%/84%/76%/65%/60% and CSS 93%/90%/82%/73%/70%, respectively (both p < 0.001). SIG stratified OS 93-68%/82-48% and CSS 97-80%/86-58% in TNM Stage II/III disease, respectively (all p < 0.001).

Conclusions: The present study shows that the pre-operative SIR in patients undergoing curative surgery for colon cancer is best measured using a SIG utilising mGPS and NLR.
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http://dx.doi.org/10.1038/s41416-021-01308-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144393PMC
May 2021

Laparoscopic colopexy for neo-left colonic volvulus 10 years after anterior resection.

J Surg Case Rep 2020 Dec 31;2020(12):rjaa555. Epub 2020 Dec 31.

Department of Colorectal Surgery, University of Sydney, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.

Recurrent neo-left colonic volvulus is a rare complication following anterior resection. The conventional approach to treating recurrent volvulus is a large bowel resection with anastomosis or colostomy formation after successful endoscopic decompression. However, in elderly and comorbid patients, this can result in significant morbidity or mortality. Laparoscopic colopexy is a less invasive alternative that has not been previously reported for the treatment of neo-left colonic volvulus. We describe a case of an 86-year-old male who presented with recurrent neo-left colonic volvulus 10 years post-laparoscopic anterior resection for cancer. A laparoscopic colopexy was performed to resolve the volvulus and prevent future recurrence. Interrupted prolene sutures were used to fix the neo-left colon to the posterior stomach and the left lateral abdominal wall. The patient had an uncomplicated postoperative recovery and was discharged 6 days after surgery. He was well at 6 months follow-up.
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http://dx.doi.org/10.1093/jscr/rjaa555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778506PMC
December 2020

The Detection of Lymphatic Invasion in Colorectal Polyp Cancer Using D2-40 Immunohistochemistry and Its Association With Prognosis.

Cureus 2020 Nov 9;12(11):e11394. Epub 2020 Nov 9.

Department of Pathology, Queen Elizabeth University Hospital, Glasgow, GBR.

Introduction The aim of this study was to compare the detection of lymphatic invasion using haematoxylin and eosin (H&E) staining versus D2-40 immunostaining on specimens from a retrospective cohort of patients with colorectal polyp cancer and to investigate the association of lymphatic invasion, detected by either method, with survival. Methods Specimens from patients with pathologically diagnosed colorectal polyp cancer were selected from the Greater Glasgow and Clyde Bowel Cancer Screening Registry for D2-40 immunohistochemistry staining. Clinicopathological information was retrieved from patient electronic records including analysis of pathology reports to determine if a lymphatic invasion was detected using H&E staining. Results Over 100 patients were included in this study with a median age at polypectomy of 66 years (range 50-76). All patients were followed up for a minimum of four years and five patients died due to colorectal cancer. The lymphatic invasion was detected in 8% of cases by H&E staining and 23% of cases with D2-40 immunostaining. Only D2-40-detected lymphatic invasion showed a statistically significant relationship with colorectal cancer-specific mortality using univariate analysis (p=0.01). Survival analysis performed separately by Cox regression demonstrated that lymphatic invasion detected by D2-40 immunostaining was associated with worse disease-specific survival (hazard ratio [HR] 14.07, 95% CI 1.57-125.97, p=0.018). Conclusion This study shows that D2-40 immunostaining can improve the detection of lymphatic invasion in colorectal polyp cancer when compared to H&E staining. In addition, the lymphatic invasion detected by D2-40 immunostaining significantly associates with survival allowing it to be used as a prognostic indicator in colorectal polyp cancer.
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http://dx.doi.org/10.7759/cureus.11394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654984PMC
November 2020

Normocytic anaemia is associated with systemic inflammation and poorer survival in patients with colorectal cancer treated with curative intent.

Int J Colorectal Dis 2019 Mar 4;34(3):401-408. Epub 2018 Dec 4.

Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.

Background: The present study aimed to characterise the prevalence and prognostic impact of normocytic anaemia in patients undergoing curative treatment for colorectal cancer.

Methods: All individuals invited to the first round of bowel cancer screening, diagnosed with colorectal cancer and treated with curative intent from April 2009 to March 2011 in a single health board were included. The modified Glasgow prognostic score (mGPS) was used to quantify preoperative systemic inflammation. Patients were grouped as having microcytic anaemia (Hb < 130 mg/L males, < 120 mg/L females and MCV < 80 fL), normocytic anaemia (Hb < 130 mg/L males, < 120 mg/L females and MCV 80-100 fL), or neither.

Results: Of 395,097 patients invited to screening during the study period, 872 were diagnosed with colorectal cancer. Seven hundred seventy-seven patients had FBC measured at diagnosis, of which 78 (10%) had microcytic anaemia, and 180 (23%) normocytic anaemia. On multivariate binary logistic regression, microcytic anaemia was associated with T stage (OR 1.92, 95% CI 1.26-2.91, p = 0.002) and mGPS (OR 1.57, 95% CI 1.10-2.24, p = 0.013), while normocytic anaemia was associated with colonic tumours (OR = 2.51, 95% CI 1.10-4.01, p = 0.025), T stage (OR 1.38, 95% CI 1.05-1.81, p = 0.022), and mGPS (OR 1.52, 95% CI 1.12-2.05, p = 0.007). On univariate Cox regression, there was no significant association between microcytic anaemia and cancer specific survival (CSS) (p = 0.969). Normocytic anaemia was significantly associated with poorer CSS (HR 1.55, 95% CI 1.13-2.12, p = 0.007).

Conclusions: Normocytic anaemia was associated with systemic inflammation and poorer CSS. Inflammation may drive both anaemia and disease recurrence in these patients, and targeting this process may improve both.
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http://dx.doi.org/10.1007/s00384-018-3211-7DOI Listing
March 2019

Factors associated with the efficacy of polyp detection during routine flexible sigmoidoscopy.

Frontline Gastroenterol 2018 Apr 26;9(2):135-142. Epub 2017 Aug 26.

Academic Unit of Colorectal Surgery, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.

Objective: Flexible sigmoidoscopy reduces the incidence of colonic cancer through the detection and removal of premalignant adenomas. However, the efficacy of the procedure is variable. The aim of the present study was to examine factors associated with the efficacy of detecting polyps during flexible sigmoidoscopy.

Design And Patients: Retrospective observational cohort study of all individuals undergoing routine flexible sigmoidoscopy in NHS Greater Glasgow and Clyde from January 2013 to January 2016.

Results: A total of 7713 patients were included. Median age was 52 years and 50% were male. Polyps were detected in 1172 (13%) patients. On multivariate analysis, increasing age (OR 1.020 (1.016-1.023) p<0.001), male sex (OR 1.23 (1.10-1.38) p<0.001) and the use of any bowel preparation (OR 3.55 (1.47-8.57) p<0.001) were associated with increasing numbers of polyps being detected. There was no significant difference in the number of polyps found in patients who had received an oral laxative preparation compared with an enema (OR 3.81 (1.57-9.22) vs 3.45 (1.43-8.34)), or in those who received sedation versus those who had not (OR 1.00 vs 1.04 (0.91-1.17) p=0.591). Furthermore, the highest number of polyps was found when the sigmoidoscope was inserted to the descending colon (OR 1.30 (1.04-1.63)).

Conclusions: Increasing age, male sex and the utilisation of any bowel preparation were associated with an increased polyp detection rate. However, the use of sedation or oral laxative preparation appears to confer no additional benefit. In addition, the results indicate that insertion to the descending colon optimises the efficacy of flexible sigmoidoscopy polyp detection.
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http://dx.doi.org/10.1136/flgastro-2017-100849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868444PMC
April 2018

Adherence to clinical practice guidelines for the treatment of candidemia at a Veterans Affairs Medical Center.

Int J Health Sci (Qassim) 2017 Jul-Sep;11(3):18-23

Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.

Objectives: The primary objective of this study was to examine the appropriateness of candidemia management at a Veterans Affairs Medical Center as recommended by the 2009 Infectious Diseases Society of America (IDSA) guidelines for treatment of infections.

Methods: A retrospective analysis of 94 adult patients with blood cultures positive for spp. was performed. Patients were stratified by severity of disease into two groups: non-neutropenic, mild-moderate disease (Group 1, = 54, 56%) and non-neutropenic, moderate-severe disease (Group 2, = 40, 42%).

Results: Adherence to the IDSA recommendations for recommended antifungal drug, dose, and duration of therapy was low in both groups (16.7% in Group 1 and 17.5% in Group 2). Although adherence was not associated with higher clinical resolution of infection ( = 0.111), it was associated with a significantly lower mortality rate ( = 0.001) when compared to variance from the guidelines at 6 weeks.

Conclusion: Although adherence to published guidelines for treating patients with candidemia was suboptimal at our institution, patients that were managed based on the guidelines had a statistically lower mortality rate.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604274PMC
September 2017

Escalation of Care in Surgery: a Systematic Risk Assessment to Prevent Avoidable Harm in Hospitalized Patients.

Ann Surg 2017 08;266(2):e27-e28

West of Scotland Virtual Journal Club, Scotland, United Kingdom, Department of General Surgery, Inverclyde Royal Hospital, Larkfield Road, Greenock PA16 0XN, United Kingdom.

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http://dx.doi.org/10.1097/SLA.0000000000001318DOI Listing
August 2017

Lower morbidity and improved outcomes in patients with screen-detected colorectal cancer.

Authors:
David Mansouri

Rev Esp Enferm Dig 2017 06 26;109(7):483-484. Epub 2017 Jun 26.

Academic Department of Surgery, University of Glasgow, UK.

Screening for colorectal cancer is now integrated into the fabric of healthcare systems across the world, as a wealth of evidence exists as regards its benefits in reducing cancer-specific mortality through the detection of early-stage disease. Options for screening include both endoscopic and stool-based tests, with a majority of countries opting for repeated faecal occult blood screening tests (FOBt). These can be either guaiac-based, as is the current system across the UK, or immunoglobulin-based, as is the case in the accompanying article from Spain. Patients testing positive for FOBt proceed to colonoscopy, where a relatively small proportion of patients, less than 10% in established screening programmes, will have a colorectal cancer identified. As national programmes have developed, multiple publications have focused on the differing aspects between colorectal cancers diagnosed through screening programmes (SD) and those diagnosed outside the screening pathway (NSD). In particular, patients diagnosed with SD tumours have been noted to be younger, more likely to be male and less socioeconomically deprived. Furthermore, tumour characteristics are different with early-stage disease and an absence of rectal tumours predominating in the SD patient group.
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http://dx.doi.org/10.17235/reed.2017.5107/2017DOI Listing
June 2017

A case of large bowel obstruction secondary to twin pregnancy.

J Obstet Gynaecol 2017 Oct 3;37(7):944-945. Epub 2017 May 3.

d University of Glasgow School of Medicine , Glasgow , UK.

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http://dx.doi.org/10.1080/01443615.2017.1306034DOI Listing
October 2017

Long-Term Follow-Up of Patients Undergoing Resection of TNM Stage I Colorectal Cancer: An Analysis of Tumour and Host Determinants of Outcome.

World J Surg 2016 Jun;40(6):1485-91

Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK.

Background: Screening for colorectal cancer improves cancer-specific survival (CSS) through the detection of early-stage disease; however, its impact on overall survival (OS) is unclear. The present study examined tumour and host determinants of outcome in TNM Stage I disease.

Methods: All patients with pathologically confirmed TNM Stage I disease across 4 hospitals in the North of Glasgow between 2000 and 2008 were included. The preoperative modified Glasgow Prognostic Score (mGPS) was used as a marker of the host systemic inflammatory response (SIR).

Results: There were 191 patients identified, 105 (55 %) were males, 91 (48 %) were over the age of 75 years and 7 (4 %) patients underwent an emergency operation. In those with a preoperative CRP result (n = 150), 35 (24 %) patients had evidence of an elevated mGPS. Median follow-up of survivors was 116 months (minimum 72 months) during which 88 (46 %) patients died; 7 (8 %) had postoperative deaths, 15 (17 %) had cancer-related deaths and 66 (75 %) had non-cancer-related deaths. 5-year CSS was 95 % and OS was 76 %. On univariate analysis, advancing age (p < 0.001), emergency presentation (p = 0.008), and an elevated mGPS (p = 0.012) were associated with reduced OS. On multivariate analysis, only age (HR = 3.611, 95 % CI 2.049-6.365, p < 0.001) and the presence of an elevated mGPS (HR = 2.173, 95 % CI 1.204-3.921, p = 0.010) retained significance.

Conclusions: In patients undergoing resection for TNM Stage I colorectal cancer, an elevated mGPS was an objective independent marker of poorer OS. These patients may benefit from a targeted intervention.
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http://dx.doi.org/10.1007/s00268-016-3443-zDOI Listing
June 2016

Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival.

Int J Colorectal Dis 2014 May 22;29(5):591-8. Epub 2014 Mar 22.

Academic Unit of Surgery, University of Glasgow, 4th Floor Walton Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK,

Purpose: The majority of patients with node-negative colorectal cancer have excellent 5-year survival prospects, but up to a third relapse. Strategies to identify patients at higher risk of adverse outcomes are desirable to enable optimal treatment and follow-up. The aim of this study was to examine postoperative mortality and longer-term survival by mode of presentation for patients with node-negative colorectal cancer undergoing surgery with curative intent.

Methods: Patients from 16 hospitals in the west of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Postoperative mortality and 5-year relative survival by mode of presentation were recorded.

Results: Of 1,877 patients with node-negative disease, 251 (13.4%) presented as an emergency. Those presenting as an emergency were more likely to be older (P = 0.023), have colon rather than rectal cancer (P < 0.001), have pT4 stage disease (P < 0.001), have extramural vascular invasion (P = 0.001), and receive surgery under the care of a nonspecialist surgeon (P < 0.001) compared to those presenting electively. The postoperative mortality rate was 3.3% after elective and 12.8% after emergency presentation (P < 0.001). Five-year relative survival was 91.8% after elective and 66.8% after emergency presentation (P < 0.001). The adjusted relative excess risk ratio for 5-year relative survival after emergency relative to elective presentation was 2.59 (95% CI 1.67-4.01; P < 0.001) and 1.90 (95% CI 1.00-3.62; P = 0.049) after exclusion of postoperative deaths.

Conclusions: Emergency presentation of node-negative colorectal cancer treated with curative intent was independently associated with higher postoperative mortality and poorer 5-year relative survival compared to elective presentation.
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http://dx.doi.org/10.1007/s00384-014-1847-5DOI Listing
May 2014

The impact of age, sex and socioeconomic deprivation on outcomes in a colorectal cancer screening programme.

PLoS One 2013 12;8(6):e66063. Epub 2013 Jun 12.

Academic Unit of Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom.

Background: Population-based colorectal cancer screening has been shown to reduce cancer specific mortality and is used across the UK. Despite evidence that older age, male sex and deprivation are associated with an increased incidence of colorectal cancer, uptake of bowel cancer screening varies across demographic groups. The aim of this study was to assess the impact of age, sex and deprivation on outcomes throughout the screening process.

Methods: A prospectively maintained database, encompassing the first screening round of a faecal occult blood test screening programme in a single geographical area, was analysed.

Results: Overall, 395,096 individuals were invited to screening, 204,139 (52%) participated and 6079 (3%) tested positive. Of the positive tests, 4625 (76%) attended for colonoscopy and cancer was detected in 396 individuals (9%). Lower uptake of screening was associated with younger age, male sex and deprivation (all p<0.001). Only deprivation was associated with failure to proceed to colonoscopy following a positive test (p<0.001). Despite higher positivity rates in those that were more deprived (p<0.001), the likelihood of detecting cancer in those attending for colonoscopy was lower (8% most deprived vs 10% least deprived, p = 0.003).

Conclusion: Individuals who are deprived are less likely to participate in screening, less likely to undergo colonoscopy and less likely to have cancer identified as a result of a positive test. Therefore, this study suggests that strategies aimed at improving participation of deprived individuals in colorectal cancer screening should be directed at all stages of the screening process and not just uptake of the test.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066063PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680425PMC
January 2014

Screening for colorectal cancer: what is the impact on the determinants of outcome?

Crit Rev Oncol Hematol 2013 Mar 11;85(3):342-9. Epub 2012 Sep 11.

Academic Unit of Surgery, School of Medicine-University of Glasgow, 4th Floor Walton Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.

Colorectal cancer screening has been introduced across the UK following several large randomised control trials and a Cochrane review that have shown a reduction in cancer specific mortality with population based Faecal Occult Blood testing. This has been attributed to the detection of more early stage disease. It is well known that in addition to stage at presentation there are a variety of other key factors that determine a patient's outcome following a diagnosis of colorectal cancer. For example there are tumour-related factors, such the presence of venous invasion and tumour necrosis, and also host-related factors, both in terms of demographic profile and an elevated circulating host inflammatory response that have been shown to be predictive of a poorer outcome. The present review summarises both the background behind the current screening programme and the observed and anticipated impact that colorectal cancer screening will have on the key determinants of outcome.
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http://dx.doi.org/10.1016/j.critrevonc.2012.08.006DOI Listing
March 2013

Characteristics of biofilm on tunneled cuffed hemodialysis catheters in the presence and absence of clinical infection.

Am J Kidney Dis 2012 Dec 15;60(6):976-82. Epub 2012 Jul 15.

Renal Section, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA.

Background: Biofilm occurring on the surface of tunneled hemodialysis (HD) catheters is difficult to eradicate and often is associated with recurrent bacteremia. We studied biofilm formation on catheters from patients with and without bacteremia to identify the location of bacterial growth and measure biofilm thickness.

Study Design: Prospective observational study.

Setting & Participants: 76 adult HD patients; 26 had HD catheters removed for bacteremia and 50 had catheters removed for reasons other than infection.

Predictors: Segment of catheter, reason for catheter removal.

Outcomes & Measurements: Microbiological growth and biofilm thickness on the outer and luminal surfaces of extravascular and intravascular catheter segments.

Results: Catheter cultures were positive in 16 (62%) patients with bacteremia and 15 (30%) when the catheter was removed for non-infection-related reasons. In catheters with positive cultures, the outer surface of the extravascular segment was the most common site of bacterial growth (15/16 [94%] and 11/15 [73%] for bacteremic and nonbacteremic patients, respectively). Bacteremic patients had significantly thicker biofilm on all catheter surfaces, and in bacteremic patients, the biofilm was significantly thicker on the outer compared with the luminal surface for both extravascular (14.53 ± 6.17 vs 11.97 ± 5.01 μm; P < 0.001) and intravascular (12.21 ± 5.3 vs 9.46 ± 3.71 μm; P < 0.001) segments. Extravascular segments had significantly thicker biofilm compared with intravascular segments on both the outer (P < 0.001) and luminal (P < 0.001) surfaces. Similarly, in patients for whom the catheter was removed for non-infection-related reasons, the catheter had thicker biofilm on the outer compared with the inner surface in both extravascular (2.19 ± 2.84 vs 1.62 ± 2.33 μm; P < 0.001) and intravascular (1.92 ± 2.62 vs 1.29 ± 2.33 μm; P < 0.001) segments. Similar to catheters from bacteremic patients, the outer and luminal surfaces of the extravascular segments of the catheters had significantly thicker biofilm compared with their corresponding surfaces on the intravascular segments.

Limitations: Observational study.

Conclusions: The outer surface of the extravascular segment of tunneled dialysis catheters in both bacteremic and nonbacteremic HD patients has the thickest biofilm and highest microbiological yield, and biofilm is thicker in patients with bacteremia. This knowledge is important for designing preventive strategies and also in the management of patients with catheter infection.
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http://dx.doi.org/10.1053/j.ajkd.2012.06.003DOI Listing
December 2012

Antimicrobial activity of prosthetic heart valve sewing cuffs coated with minocycline and rifampin.

Antimicrob Agents Chemother 2002 Feb;46(2):543-5

Center for Prostheses Infection, Baylor College of Medicine and Veterans Affairs Medical Center, St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.

Prosthetic heart valve sewing cuffs coated with minocycline and rifampin exhibited in vitro zones of inhibition against all 52 tested clinical isolates responsible for prosthetic valve endocarditis. An in vitro elution study of these coated sewing cuffs demonstrated residual zones of inhibition against Staphylococcus epidermidis for at least 4 weeks.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC127022PMC
http://dx.doi.org/10.1128/AAC.46.2.543-545.2002DOI Listing
February 2002
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