Pediatric reference intervals for plasma free and total metanephrines established with a parametric approach: Relevance to the diagnosis of neuroblastoma.

BACKGROUND: Urine catecholamines, vanillylmandelic, and homovanillic acid are recognized biomarkers for the diagnosis and follow-up of neuroblastoma. Plasma free (f) and total (t) normetanephrine (NMN), metanephrine (MN) and methoxytyramine (MT) could represent a convenient alternative to those urine markers. The primary objective of this study was to establish pediatric centile charts for plasma metanephrines. Secondarily, we explored their diagnostic performance in 10 patients with neuroblastoma. PROCEDURE: We recruited 191 children (69 females) free of neuroendocrine disease to establish reference intervals for plasma metanephrines, reported as centile curves for a given age and sex based on a parametric method using fractional polynomials models. Urine markers and plasma metanephrines were measured in 10 children with neuroblastoma at diagnosis. Plasma total metanephrines were measured by HPLC with coulometric detection and plasma free metanephrines by tandem LC-MS. RESULTS: We observed a significant age-dependence for tNMN, fNMN, and fMN, and a gender and age-dependence for tMN, fNMN, and fMN. Free MT was below the lower limit of quantification in 94% of the children. All patients with neuroblastoma at diagnosis were above the 97.5th percentile for tMT, tNMN, fNMN, and fMT, whereas their fMN and tMN were mostly within the normal range. As expected, urine assays were inconstantly predictive of the disease. CONCLUSIONS: A continuous model incorporating all data for a given analyte represents an appealing alternative to arbitrary partitioning of reference intervals across age categories. Plasma metanephrines are promising biomarkers for neuroblastoma, and their performances need to be confirmed in a prospective study on a large cohort of patients. Pediatr Blood Cancer 2015;62:587-593. © 2015 Wiley Periodicals, Inc.

Surgical treatment of perforated peptic ulcer. Is there a need for a change?

The aim of this study is to evaluate the risk and the results of surgical treatment for perforated peptic ulcer (PPU), to compare them through time, and to determine the current optimal surgical treatment. In a retrospective study, the charts of all the patients admitted for PPU between January 1976 and October 1991 were reviewed. The features believed to be of importance in the outcome were assessed for statistical analysis. A comparison was made between three periods of the study (1976-1980, 1981-1985, 1986-1991). 247 patients were included. Mortality was 11.7% (29/247). Factors associated with an increased mortality were: shock on admission (p = 0.01), age (p < 0.001), severe associated medical illnesses (p < 0.001) and the form of treatment (p < 0.01). After multivariate analysis, only shock on admission and associated disease remained significant. Chronic peptic ulcer disease occurred in 76% of the patients. Comparing the periods showed that age, associated illnesses, percentage of acute or subacute ulcers, mortality, as well as the number of patients, are increasing. The main determinant of surgical treatment for PPU is the patient and his/her general state. Because of the high frequency of chronic peptic ulcer disease, we believe that the gold standard in the treatment for PPU remains definitive surgery. However, in the presence of more than one risk factor, suture and patch are probably safer.

Neck complaints in the pediatric emergency department: a consecutive case series of 170 children.

OBJECTIVES: To describe the spectrum of pathologies responsible for neck ailments in a primary care pediatric emergency setting and evaluate their outcome. METHODS: All children aged 16 years or younger, who presented to the emergency department of the Children's Hospital of Lausanne during a 1-year period, were retrospectively identified and charts were reviewed. Causes of neck complaints were classified as traumatic (group 1), infectious (group 2), postural (group 3), or miscellaneous (group 4) according to the final diagnosis. History and physical examination findings, radiological and laboratory results, as well as patient outcomes were recorded. RESULTS: During the study period, 28,722 children were observed in the emergency department, and 170 were identified as having neck complaints. The number of patients with neck ailments in group 1 was 105 (62%). Group 2 contained 33 patients (19%), of which 28 (16.5%) had a viral infection and 5 (2.9%) had a bacterial infection. Group 3 contained 30 children (17.6%) and group 4 contained 2 children (1.2%). Cervical spine radiography was performed on an emergency basis in 60 children (57 in group 1, 2 in group 2, and 1 in group 3). Significant abnormalities were observed in 6 children. Cervical computed tomography (CT) was performed in 9 children, from which 5 were in group 1, 3 were in group 2, and 1 was in group 4. The CT scan revealed pathologic findings in 6 children. Follow-up data were available in 135 patients (79.4%), of which 129 (95.6%) experienced complete recovery in less than 2 weeks. Admission to the hospital was necessary in 4 children (1 in group 1 and 3 in group 2), including 2 for emergency surgical drainage of retropharyngeal abscesses. One child with posttraumatic torticollis was treated conservatively as an outpatient and recovered in 7 weeks. One child was had his/her condition eventually diagnosed with osteoid osteoma and treated with oral nonsteroidal anti-inflammatory drug. CONCLUSIONS: Most cases of neck ailments in children presenting to the emergency department were due to trauma or infection, which were effectively managed as outpatients. When signs and symptoms suggested an emergent cause, CT provided a definitive diagnosis. The evaluation of a child presenting with acute neck complaints should be based on history and physical examination. Plain radiographs and CT scan are contributive in selected cases.

Sulfaattiselluloosatehtaan rikki- ja natriumtase sekä kemikaalikierron malli

Tämän diplomityön kirjallisessa osassa on tarkasteltu sulfaattiselluloosatehtaan ympäristöpäästöjen vähentämiseen liittyvää ongelmallisuutta sekä luomaan pääpiirteittäinen kuvaus sulfaattiselluloosatehtaan kemikaalikierrosta lähinnä rikki- ja natriumyhdisteiden kiertoja huomioiden. Pääasiassa kemikaalisäästöjen ja ympäristösyiden vuoksi tehtävää kemikaalikierron sulkemista seuraa rikki- ja natriumtaseisiin sekä kemikaalikierron vierasaineisiin liittyviä ongelmia, kuten prosessilaitteistojen likaantumista, korroosiota ja hajukaasuyhdisteiden muodostumista. Diplomityön mallinnusosassa on luotu Metsä-Botnian Rauman sellutehtaan kemikaalikierron malli pohjautuen tehtaan virtauskaavioihin sekä muuhun tehtaalta saatuun prosessi-informaatioon. BALAS-simulointiohjelmiston avulla luotuja mallikaavioita on käytetty hyväksi tehtaan kokonais- rikki- ja natriumtaseiden laskennassa. Varsinainen simulointi on jätetty projektin aikataulullisten syiden vuoksi jatkoprojektin piiriin.

Osavalmistuksen kustannustehokkuuden arviointi

Tämän diplomityön tarkoituksena oli selvittää osavalmistuksen kustannustehokkuutta Ruukki Engineering Seinäjoen palvelukeskuksessa. Osavalmistuksessa osia leikataan, särmätään ja viimeistellään kokoonpanohitsaukseen soveltuviksi komponenteiksi. Kustannustehokkuuden selvittämisessä käytettiin aikaan perustuvia mittausmenetelmiä, joiden pohjalta laskettiin tuotteen toteutuneita kustannuksia. Toteutuneita kustannuksia verrattiin hinnoittelutaulukoihin. Vertailussa havaittiin, että kaikkia työvaiheita ei ollut hinnoiteltu lainkaan. Erot hinnoittelun ja toteutuneiden kustannusten välillä olivat merkittäviä. Työssä tutkittiin myös jalostavan ajan osuutta kokonaisläpäisyajasta. Mitattuja tietoja verrattiin kahteen aikaisemmin tehtyyn tutkimukseen. Osavalmistuksessa aikaa kuluu paljon välivarastoissa ja työvaiheiden läpäisyajat olivat joidenkin työvaiheiden kohdalla pitkiä. Diplomityön tulokset olivat vertailukelpoisia muiden tutkimustenkanssa ja olivat ennalta asetettujen hypoteesien mukaisia.

Illite "crystallinity'' revisited

The Kubler Index (KI) is defined as the full width at half-maximum height (FWHM) of the 10-Angstrom X-ray diffraction peak of illite-smectite interstratified (I-S) clay minerals, The only parameters controlling the Kubler index are assumed to be the mean number of layers (N) in the coherent scattering domains (CSD). the variance of the distribution of the number of layers of the CSB, the mean percentage of smectite layers in I-S (%S), and the probability of layer stocking (Reichweite). The Kubler-Index measurements on ah-dried (KIAD) and ethylene-glycolated (KIEG) samples were compared to N and %S using the NEWMOD computer program to simulate X-ray diffraction patterns. Charts of KIAD versus KIEG corrected for instrumental broadening were made and isolines were mapped for constant N and CLS. Isolines allow a direct and rapid determination of N and RS from KI measurements. The method allows quantification of the metamorphic anchizone limits by considering mean thickness of fundamental particles in MacEwan crystallites. The transition from diagenesis to the anchizone and from the anchizone to the epizone of low-grade metamorphism corresponds to thicknesses of 20- and 70-layer fundamental particles, respectively.

The last days of dying stroke patients referred to a palliative care consult team in an acute hospital.

BACKGROUND AND PURPOSE: Needs of patients dying from stroke are poorly investigated. We aim to assess symptoms of these patients referred to a palliative care consult team, and to review their treatment strategies. METHODS: All charts of patients dying from stroke in a tertiary hospital, and referred consecutively to a palliative care consultant team from 2000 to 2005, were reviewed retrospectively. Symptoms, ability to communicate, treatments, circumstances and causes of death were collected. RESULTS: Forty-two patients were identified. Median NIH Stroke Scale on admission was 21. The most prevalent symptoms were dyspnoea (81%), and pain (69%). Difficulties or inability to communicate because of aphasia or altered level of consciousness were present in 93% of patients. Pharmacological respiratory treatments consisted of anti-muscarinic drugs (52%), and opioids (33%). Pain was mainly treated by opioids (69%). During the last 48 h of life, 81% of patients were free of pain and 48% of respiratory distress. The main causes of death were neurological complications in 38% of patients, multiple medical complications in 36%, and specific medical causes in 26%. CONCLUSIONS: Patients dying from stroke and referred to a palliative care consult team have multiple symptoms, mainly dyspnoea and pain. Studies are warranted to develop specific symptoms assessment tools in non-verbal stroke patients, to accurately assess patients' needs, and to measure effectiveness of palliative treatments.

Laboratory diagnosis of brucellosis in a rural endemic area in northeastern Spain

Sera obtained from 62 patients from four mountain counties in Catalonia (Northeastern Spain), in whom brucellosis had been diagnosed on the basis of clinical evidence and/or personal history, were analyzed using the rose Bengal test, standard serum agglutination test (SAT), Coombs" test, ELISA, and complement fixation. The diagnosis was further confirmed through blood cultures. Clinical evidence, epidemiology, and the results from serologic tests were used to assign patients to one of two groups: group 1 (n = 38) patients had primary infections, whereas group 2 (n = 24) patients had been previously exposed to the microorganism, i.e. re-infection of group 2 individuals occurred after long periods of time during which no active infection by Brucella had been detected. Receivingoperating charts (ROC) were used to determine the diagnostic value of the different tests and to establish discriminant values. Blood culture was a valuable diagnostic tool in group 1 (0.92 sensitivity) but was inappropriate in group 2 (0.08). The combination of positive rose Bengal test and agglutination ≥1/160 was valid for diagnosis in group 1. In group 2, agglutination < 1/160 (including negative agglutination) did not rule out brucellosis. The combination of positive rose Bengal test and Coombs" test ≥1/320 was the best diagnostic criterion (0.8 specificity; 1 sensitivity). ELISA (for IgG, IgM, or both) did not improve diagnostic accuracy

AV40 - Técnicas de rediseño. Prototipos virtuales

Aplicación de diferentes técnicas propias de la Metodología del Diseño para la mejora de un producto industrial previamente seleccionado

Tilastotietojen graafinen esittäminen WWW-sivulla

World Wide Webin suosiolla on ollut merkittävä vaikutus yhteiskuntaan. WWW-sivut ovat helposti saatavilla ja sisällön tekeminen WWW:hen on helppoa. WWW-ympäristölle myös kehitetään paljon sovelluksia. WWW-sovellusten kehittämiselle ominaista on valinnanvapaus ja nopeuden tavoittelu. WWW-sovellusten ohjelmoinnin mahdollistavat useat toisilleen vaihtoehtoiset tekniikat. Ne eroavat toisistaan suoritusnopeudessa, ominaisuuksien määrässä ja joustavuudessa. Ohjelmoinnissa käytetään apuna useita erilaisia menetelmiä. Apumenetelmiä ovat muun muassa työkalut ja valmiiden komponenttien hyödyntäminen. Valmiit komponentit voivat olla joko ilmaisia, avointa lähdekoodia tai maksullisia. Tämän kandidaatintyön aikana valmistui sovellus, joka piirtää tilastotiedoista kaaviokuvia ja näyttää niitä dynaamisella WWW-sivulla. Sovellus pyrittiin toteuttamaan älykkäästi apumenetelmiä sopivasti hyödyntäen. Sovelluksen kehittämisessä käytettiin apuna sekä ohjelmointityökaluja että valmiita komponentteja. Kaaviokuvien tyypin ja ulkoasun haluttiin olevan käyttäjien muokattavissa. Toisaalta sovelluksen haluttiin olevan helposti laajennettavissa. Vaatimuksiin vastattiin tekemällä kaaviokuvien piirrosta osittain tietokannalla ohjelmoitava.

Assessment of inflammatory Bowel Disease patient's needs and problems from a nursing perspective

BACKGROUND: In this study, we aimed at assessing Inflammatory Bowel Disease patients' needs and current nursing practice to investigate to what extent consensus statements (European Crohn's and Colitis Organization) on the nursing roles in caring for patients with IBD concur with local practice. METHODS: We used a mixed-method convergent design to combine quantitative data prospectively collected in the Swiss IBD cohort study and qualitative data from structured interviews with IBD healthcare experts. Symptoms, quality of life, and anxiety and depression scores were retrieved from physician charts and patient self-reported questionnaires. Descriptive analyses were performed based on quantitative and qualitative data. RESULTS: 230 patients of a single center were included, 60% of patients were males, and median age was 40 (range 18-85). The prevalence of abdominal pain was 42%. Self-reported data were obtained from 75 out of 230 patients. General health was perceived significantly lower compared with the general population (p < 0.001). Prevalence of tiredness was 73%; sleep problems, 78%; issues related to work, 20%; sexual constraints, 35%; diarrhea, 67%; being afraid of not finding a bathroom, 42%; depression, 11%; and anxiety symptoms, 23%. According to experts' interviews, the consensus statements are found mostly relevant with many recommendations that are not yet realized in clinical practice. CONCLUSION: Identified prevalence may help clinicians in detecting patients at risk and improve patient management. © 2015 S. Karger AG, Basel.

Sagittal abdominal diameter is a better predictor than body mass index for duration of laparoscopic left colectomy.

BACKGROUND: Visceral obesity (VO) increases technical difficulty in laparoscopic surgery. The body mass index (BMI) does not always correlate to intra-abdominal fat distribution. Our hypothesis was that simple anthropometric measures that reflect VO, could predict technical difficulty in laparoscopic colorectal surgery, as reflected by the operative time, more accurately than the BMI. METHODS: Charts of all consecutive patients who underwent laparoscopic left colon resection in our institution between 2007 and 2010 were reviewed retrospectively. On a preoperative CT scan, anthropometric measures were taken on an axial plane at the L4-L5 level. Demographic, operative and anthropometric CT measures were correlated with the operative time. Logistic regression analysis was performed to assess the value of anthropometric CT measures or BMI to predict the duration of the colectomy. RESULTS: 121 patients with elective left colon resection for benign (56%) or malignant disease (44%) were included. There were 74 sigmoid resections (61%), 21 left hemicolectomies (17%) and 26 low anterior resections (22%). A longer sagittal abdominal diameter (≥24.8 cm) was significantly associated with longer corrected operative time (248 vs. 228 min, p = 0.043). In multivariate analysis, greater sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter were significantly associated with longer operative time. No significant association was found for the BMI neither in univariate nor in multivariate analysis. CONCLUSIONS: This study suggests that simple linear measures taken on a CT scan, such as sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter, may predict longer operative time in laparoscopic left colonic resections more accurately than BMI.

AV38 - Cuadros morfológicos

Aplicación de las matrices morfológicas como metodología de rediseño industrial

Cancer incidence in Neuchâtel (2003-2007)

REGISTRATION AREA: The Neuchâtel Cancer Registry covers the Frenchspeaking canton of Neuchâtel in western Switzerland, which shares a border with France. The canton is mainly rural, with only two cities (of approximately 35 000 residents each). Almost all residents are Caucasian; 38% are Protestant and 31% are Catholic. Foreign residents (predominantly of Mediterranean origin) account for about 23% of the population. The main occupational sectors in the canton are watch-making and the microtechnical industry (35%), agriculture (4%), and services (61%). REGISTRY STRUCTURE AND METHODS: The bulk of information is provided by the Neuchâtel Institute of Pathology (INAP) through submission of biopsy, cytology, and autopsy reports. Notiĺcation is voluntary for medical institutions. Additional information is abstracted by the registry staff from computerized hospital charts. The registry routinely integrates abstracts of medical records into its database, and performs periodic electronic linkage between the registry database and the centralized cantonal administrative population database (for the purpose of active follow-up). All death certiĺcates are checked annually against the registry ĺles.

Implementation of Signaling Gateway between Telephone Network and the Internet

Tässä diplomityössä perehdytään verkkoelementiltä, joka yhdistää H.323, MEGACO- ja ISUP-protokollia käyttävät tietoliikenneverkot toisiinsa, vaadittaviin ominaisuuksiin ja toiminnallisuuksiin. Tyypillisesti tällaista toiminnallisuutta tarvitaan IP- ja PSTN-verkkojen yhdistämisessä. Tarkastelu aloitetaan kuvaamalla PSTN-verkon signalointi ja rakenne, jatketaan kuvaamalla internet-protokollia käyttävä verkkoympäristö ja lopuksi perehdytään verkkoelementiltä vaadittaviin toiminnallisuuksiin, jotta PSTN ja MEGACO-pohjaiset verkot toimivat yhteen. Työn käytännöllisenä osuutena kuvataan osa viestisekvenssikaavioista, joita verkkoelementti toteuttaa puuttumatta kuitenkaan eri protokollien toimintaan viestien parametrien tasolla.