Accuracy of immunological fecal occult blood testing for colorectal cancer screening

The presence of a specific SOD surface membrane receptor in rat hepatocyte cells was investigated using ligand blot analysis of the SOD receptor with 125I-SOD, and binding studies with iodinated and fluorescinated SOD. A specific SOD receptor with a molecular weight of about 320 kDa was identified. We suggest that the modulatory role of SOD on HMG-CoA reductase is exerted through this specific receptor.     

Population based randomized study of uptake and yield of screening by flexible sigmoidoscopy compared with screening by faecal occult blood testing

OBJECTIVES: To compare the feasibility of mass screening by flexible sigmoidoscopy with screening by faecal occult blood testing (Haemoccult) and both tests combined. DESIGN: Patients were randomised to screening by flexible sigmoidoscopy, faecal blood testing, or both tests. The flexible sigmoidoscopy examinations were performed by a general practitioner. SETTING: General practice. SUBJECTS: 3744 patients aged 50-75 years. Main outcome measures: Uptake, positive results, detection of neoplasia, complications, and recall for diagnostic colonoscopy. RESULTS: Uptake was significantly higher in the flexible sigmoidoscopy group (46.6%) than in the faecal blood test group (31.6%; P<0.001) or than in the group having both tests (30.1%; P<0.001). Telephone reminders increased uptake of sigmoidoscopy to 61.8%. In total, 1116 sigmoidoscopy examinations were performed without major complication. Polyps were found in 19. 3% (95% confidence interval 17.0% to 21.6%) but only 6.8% (5.3% to 8. 3%) had adenomas and 2.4% (1.5% to 3.3%) "high risk" adenomas. Cancer was detected in four subjects. The faecal blood test yielded positive results in 0.8% (0.2% to 1.4%) but missed at least one cancer and 30 cases of adenoma which were found by sigmoidoscopy in the combined group. Use of histological criteria-shown elsewhere to correlate with future risk of colorectal cancer-to select "positive" patients could reduce recall for diagnostic colonoscopy from about 20% to less than 5%. CONCLUSIONS: Some of the predicted obstacles to screening with flexible sigmoidoscopy are surmountable. Clear evidence relating to efficacy will be obtained only from a randomised controlled trial.     

Immunologic detection of fecal occult blood from upper digestive tract diseases

BACKGROUND/AIMS: This study was conducted to evaluate the accuracy of the immunochemical occult blood test for upper digestive tract diseases. METHODOLOGY: The test was performed on 226 subjects, including 124 upper digestive tract diseases (12 ulcerative esophagitis cases, 10 esophageal cancer cases, 33 gastric ulcer cases, 33 gastric cancer cases, and 36 duodenal ulcer cases), 34 colorectal cancer cases, and 68 healthy subjects, after which, the accuracy of this test was evaluated. RESULTS: The test was positive 23 in upper digestive tract diseases (2 in ulcerative esophagitis, 2 in esophageal cancer, 5 in gastric ulcer, 8 in gastric cancer, 6 in duodenal ulcer), 31 in colorectal cancer, and 3 in healthy subjects, respectively. Thus, the sensitivity was 19% for upper digestive tract diseases (16.7% for ulcerative esophagitis, 20% for esophageal cancer, 15% for gastric ulcer, 24% for gastric cancer, 20% for duodenal ulcer) and 91% for colorectal cancer, and the specificity was 96%. Significant difference was noted in the sensitivity between upper digestive tract diseases and colorectal cancers (p0.001), whereas there was no difference among 5 upper digestive tract diseases. CONCLUSIONS: These results indicate that the immunochemical occult blood is inadequate as means for detection of upper digestive tract diseases, and that an examination of upper digestive tract is unnecessary in cases where the immunochemical occult blood test is positive, but there is no evidence of diseases in colon and rectum.     

Reduction in risk of mortality from colorectal cancer by fecal occult blood screening with immunochemical hemagglutination test. A case-control study

Fecal occult blood testing by immunochemical hemagglutination has been shown to be superior to the Hemoccult test, both in sensitivity and in specificity. The test has been widely used as a tool for population screening in Japan, but there has been no study to evaluate the efficacy of screening using this test. A case-control study to evaluate the screening was conducted in study areas where no previous and no other concomitant colorectal cancer screening had been performed. Case series in the study were 193 cases who died of colorectal cancer. Three controls were selected randomly from the list of individuals who were alive at the time of diagnosis of the corresponding case and had been living in the same area as the case, matched by gender and by age. Odds ratios (OR) of dying of colorectal cancer for those screened within 1, 2 and 3 years of case diagnosis vs. those not screened were 0.40 [95% confidence interval (CI) 0.17-0.92], 0.41 (95% CI 0.20-0.82), and 0.48 (95% CI 0.25-0.92), respectively. OR increased towards 1.0 as the duration during which screening histories were compared was extended, and showed similar tendencies when analyzed by number of years since the most recent screening history. These results suggest that colorectal cancer screening by the immunochemical fecal occult blood test would reduce mortality from colorectal cancer.     

Double immunochemical screening test (hemoglobin and albumin) for the detection of occult intestinal bleeding

BACKGROUND AND OBJECTIVES: Chlamydia trachomatis antigen testing of clinical specimens is replacing culture as the test of choice. Because of a potential for false positive results in low prevalence populations, there is an apparent need for confirming specimens positive by enzyme immunoassay (EIA). GOAL OF THIS STUDY: To examine specimens falsely positive in the Chlamydiazyme EIA assay according to gender and specimen type. STUDY DESIGN: Testing of genitourinary specimens from men and women consecutively enrolled from five health care delivery sources in an urban Canadian population. All specimens were initially tested in the Chlamydiazyme test and all positives repeated in a confirmatory blocking assay provided by the manufacturer. Additional confirmatory testing was performed using immunofluorescence (IF) staining for C. trachomatis elementary bodies (EB's) and polymerase chain reaction (PCR). RESULTS: From Jan. 1, 1990 to June 1, 1991, multiple specimens from 656 men and 5,628 women of varying population prevalences were screened. EIA-positive specimens from women had a repeat negative rate of 22% to 27% from cervical swabs and 29% from urethral swabs. Male urethral swabs had a high repeat negative rate of 22% when EIA was the only positive test, but 2.4% when the specimen was positive by EIA and culture. EIA-positive first void urine (FVU) specimens from men had a repeat negative rate of 8.7% as opposed to 17% to 32% from women. Only 1.7% (2/115) of male FVU did not block compared to rates of 47% (22/47) to 80% (4/5) in FVU from women. Analysis of EIA optical densities (OD's) and EB counts showed an association between the absorbance range 0.1 to 1.4 OD and 0-85 EB's. The greatest number of EB's and highest OD's were seen with cervical specimens, followed by urine and urethral specimens in women infected at all three specimens. All 55 specimens that did not confirm in the blocking test had no EB's and a convenience sample of seven were negative by PCR. All of a subset of 50 blocked specimens contained EB's or were positive by PCR. CONCLUSIONS: Although a variable proportion of specimens may not repeat positive in the EIA, use of the blocking reagent to confirm the repeat positives is highly recommended and the rate of blocking may be heavily influenced by gender and specimen type.     

A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult

OBJECTIVE: To review effectiveness of screening for colorectal cancer with faecal occult blood test, Hemoccult, and to consider benefits and harms of screening. DESIGN: Systematic review of trials of Hemoccult screening, with meta-analysis of results from the randomised controlled trials. SUBJECTS: Four randomised controlled trials and two non-randomised trials of about 330 000 and 113 000 people respectively aged >=40 years in five countries. MAIN OUTCOME MEASURES: Meta-analysis of effects of screening on mortality from colorectal cancer. RESULTS: Quality of trial design was generally high, and screening resulted in a favourable shift in the stage distribution of colorectal cancers in the screening groups. Meta-analysis of mortality results from the four randomised controlled trials showed that those allocated to screening had a reduction in mortality from colorectal cancer of 16% (relative risk 0.84 (95% confidence interval 0.77 to 0.93)). When adjusted for attendance for screening, this reduction was 23% (relative risk 0.77 (0.57 to 0.89)) for people actually screened. If a biennial Hemoccult screening programme were offered to 10 000 people and about two thirds attended for at least one Hemoccult test, 8.5 (3.6 to 13.5) deaths from colorectal cancer would be prevented over a period of 10 years. CONCLUSION: Although benefits of screening are likely to outweigh harms for populations at high risk of colorectal cancer, more information is needed about the harmful effects of screening, the community's responses to screening, and costs of screening for different healthcare systems before widespread screening can be recommended.     

Noninvasive detection of intracranial vascular lesions by recording blood flow sounds

The actions of S-alpha-fluoromethylhistidine (FMH), an irreversible inhibitor of the histamine biosynthetic enzyme histidine decarboxylase (HD), were studied on rat brain HD, as measured by a recently developed CO2-trapping enzymatic method. As expected, FMH induced a virtually complete inhibition of HD in the hypothalamus both in vivo and in vitro. In the frontal cortex, however, maximal doses of FMH did not maximally inhibit HD, suggesting the existence of an FMH-resistant form of HD. Careful studies of the conditions under which the assays were performed (homogenate dilution, preincubation times, incubation times, temperatures), as well as experiments with inhibitors of other decarboxylases, were unable to provide an explanation for this. When comparable studies of the effects of FMH in these brain regions were performed by alternative methods for measuring HD activity, no evidence for the existence of an FMH-resistant form of HD could be found. Thus, even though the CO2-trapping method appears to be accurate for measuring HD activity in rat hypothalamic homogenates, the present results show that this method may not be specific when studying brain regions other than the hypothalamus.     

The role of cuspal flexure in the development of abfraction lesions: a finite element study

OBJECTIVE: A suggested cause of idiopathic scoliosis (IS) in children is a disequilibrium in the vestibulospinal control of trunk muscles. We sought a correlation between otolith vestibular dysfunction and IS. METHODS: A recently developed test for evaluation of otolith vestibular function (off-vertical axis rotation, OVAR) was applied to 30 children with IS, 12 control subjects, and 3 with congenital scoliosis as a result of spinal deformities. RESULTS: Of the patients with IS, 67% had significantly greater values of directional preponderance on the OVAR test (a measure of otolith system imbalance) compared with control subjects. Patients with congenital scoliosis showed normal responses on the OVAR test. No correlation was found between the direction of the preponderance and the side of the spine imbalance, or between the directional preponderance and the curve magnitude. The rate of progression of the scoliosis was not significantly correlated with the amplitude of the directional preponderance. CONCLUSION: These results support the hypothesis that central otolith vestibular system disorders lead to a vestibulospinal system imbalance, and may be a factor in the cause of IS.     

A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment

BACKGROUND: This review was commissioned because of the increasing doubt about the ability of existing screening programmes (mainly the health visitor distraction test (HVDT) at 7-8 months) to identify children with congenital hearing impairment, and technological advances which have made neonatal hearing screening an alternative option. OBJECTIVES: To review the available literature on the screening of permanent childhood hearing impairment. To provide commissioners and providers of health care with information about how to deliver a more uniform service, better outcomes, and more cost-effective screening. To identify areas for further research and service development. HOW THE RESEARCH WAS CONDUCTED: The research involved a review of the available published and unpublished literature, and a comprehensive survey of current pre-school hearing screening provision in the UK coupled with a health economics study of hearing screening costs. The research also included a number of focus groups and visits to key centres in the UK and North America. RESEARCH FINDINGS: EPIDEMIOLOGY OF PERMANENT CHILDHOOD HEARING IMPAIRMENT: There are approximately 840 children a year born in the UK with significant permanent hearing impairment likely to affect their own and their family's quality of life. Present services will miss about 400 of these children by 1 1/2 years of age, and about 200 of these children by 3 1/2 years of age. Such late identification of hearing impairment greatly reduces the responsiveness of the services for individual children. EVIDENCE FOR IMPROVED OUTCOMES WITH EARLIER IDENTIFICATION: Hearing-impaired children identified late are at risk of substantial delay in their acquisition of language and communication skills, with consequent longer-term risk to education achievement, mental health and quality of life. Theoretical arguments on neural development support the limited evidence here for the increased benefit for child and family associated with very early identification. In general, parents and professionals want very early identification, which, if implemented properly, does not cause undue anxiety. CURRENT UK PRACTICE: The survey of current practice indicated a major problem with poor information systems. This problem was further highlighted as a major concern by the multi-disciplinary focus groups. Practice varies. There are two District-wide programmes in which all newborn babies are neonatally screened, a large number of ad hoc programmes for neonatal screening of 'at-risk' babies, a variety of early surveillance programmes, and widespread use of the HVDT. Intervention and habilitation for the majority of those screened neonatally is routinely undertaken within 6 months of birth. For those screened only by the health visitor, identification was on average at about 26 months of age with intervention at about 32 months on average. (ABSTRACT TRUNCATED)     

Nutritional screening for the elderly: a CNS role

We report a cytogenetic and fluorescence in situ hybridization study of a family in which a female child showed all the main characteristics of Angelman syndrome. Her karyotype revealed a translocation between chromosomes 5 and 15 with a partial deletion from 15pter to the Angelman region. Several members of her family appeared to be carriers of the same translocation, but showed no symptoms. The karyotypes showed a marker chromosome, that was not present in the female with Angelman syndrome. Fluorescence in situ hybridization revealed that the marker chromosome corresponded to material from chromosome 15. The present study is in agreement with the suggestion that genomic imprinting is one of the mechanisms involved in Angelman syndrome.     

The Minnesota Infant Development Inventory in the developmental screening of high-risk infants at eight months.

Compared the results of a parent-completed questionnaire, the Minnesota Infant Development Inventory (MIDI), with Bayley Scales of Infant Development (BS) for 86 high-risk 8-mo-olds. Categorization of Ss as delayed or not delayed on 5 subscales of the MIDI showed good overall agreement with BS findings. Categorization of Ss based on their lowest MIDI subscale score yielded good sensitivity in detecting delay and fair specificity in identifying normal development. Multiple regression analysis indicated that the Gross Motor scale score was the strongest predictor of performance on BS items. Results suggest the potential utility of the MIDI as a screening tool in follow-up programs monitoring the development of high-risk infants. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who gets repeat screening mammography: the role of the physician

To determine rates of, and explore physician factors associated with, repeat mammography, administrative data for 791 women aged 50 years and older were examined. Three-fourths of the women (73%) received repeat mammography (i.e., a second mammogram was obtained within six to 18 months of the first). Provider factors associated with higher repeat mammography rates were: being a woman, practicing in the women's health group rather than the general internal medicine service, and being a fellow or an attending physician (p-values < 0.01). Patients of women attendings/fellows had higher repeat mammography rates than did those of men attendings/fellows, men residents, and women residents. Characteristics (gender, level of training) of providers strongly influence their patients' screening behavior.     

Sensitivity of immunochemical occult blood testing in detecting early colorectal cancer

Sensitivity of immunochemical occult blood testing (IFOBT) for early colorectal cancer (CRC) calculated in known cases is reported to be around 50-60%. Sensitivities of IFOBT for cancer in the preclinical stage were reported based on findings of colonoscopy performed on all screenees. Of 5715 asymptomatic persons who underwent flexible sigmoidoscopy (FS), 13 cases of early cancer were found, within the reach of FS. Sensitivities were 53.8%, 76.9 and 84.6% for one-day test, two-day test and three-day test of IFOBT by immunochemical hemagglutination, respectively. While corresponding figure was only 15.4% for three-day Hemoccult test. Other reports indicated that sensitivity of IFOBT is around 30% for small lesions of early CRC less than 1 cm in diameter. IFOBT is much more sensitive in detecting early CRC than Hemoccult test but is poorly sensitive for tiny early CRC.