New Colorectal Cancer Screening Guidelines Focus on Prevention

A consortium of cancer groups has published new guidelines for screening colorectal cancer, which for the first time focus on prevention and early detection.

The guidelines are published online in CA, A Cancer Journal for Clinicians and were issued by the American Cancer Society Colorectal Cancer Advisory Group, the US Multi-Society Task Force, and the American College of Radiology Colon Cancer Committee.

The new guidelines add two new screening tests: stool DNA and CT or "virtual" colonography to the existing list that already includes options such as the more familiar colonoscopy and double contrast barium enema.

The new recommendations are also more specific about the pros and cons of the different options, for instance some of the more invasive tests are more likely to prevent cancer because they find pre-cancerous polyps which can be removed before the disease develops. Other tests are less likely to find pre-cancerous growths, but still detect most cancers, said the American Cancer Society (ACS) in a press statement.

The aim of the guidelines is to help doctors and patients make better decisions about colon cancer screening.

They are written for people over 50 with an average risk of developing colon cancer and anyone with a higher than normal risk should have more intensive screening, said the ACS.

Colorectal Cancer (CRC, also shortened to colon cancer) is the third most common cancer diagnosed among American men and women and the second leading cause of cancer death in the US. The ACS said that although the rates of new cases is going down, there would be even fewer if more people who should be screened actually did.

All types of screening have the potential to find early stage cancer, but only some can find pre-cancerous growths, which are easier to treat.

The guidelines only include tests described in scientific literature as being able to detect at least 50 per cent of cancers.

The figures show that where colon cancer is stopped before it has spread to lymph nodes and other organs, 90 per cent of patients survive more than 5 years after diagnosis. This compares with a 10 per cent rate of survival for 5 years or more among patients whose cancer has spread.

The guidelines recommend that where tests are available, and patients are willing, doctors should encourage testing for both polyps and cancer.

Dr. Durado Brooks, Director of Prostate and Colorectal Cancer at the ACS said this was the first time such guidelines have stated a preference for one type of test over another, explaining that:

"In the past we've created a list [of options] and left it up to providers and patients to decide what would work best for them."

But now, it is becoming clearer with research that some tests are more likely to help prevent cancer, he said, "and for the first time our guidelines state that colorectal cancer prevention should be the primary goal of screening".

Also, while the guidelines suggest some tests are better than others, the main thing is to get tested, said Brooks, explaining that:

"The best test is the test the patients can get and will take, but patients should be aware that there is a greater potential for certain types of tests to prevent cancer."

The new guidelines give 4 tests that give the best chance of finding both polyps and cancer:

1. Flexible sigmoidoscopy (recommended every 5 years).
2. Colonoscopy (every 10 years).
3. Double contrast barium enema (every 5 years).
4. CT (computer tomography or "virtual") colonography (every 5 years).

In sigmoidoscopy and colonoscopy tests, a camera on the end of a flexible tube is inserted in the patient's rectum and colon to see if there are any polyps or cancers. Any polyps found can be removed during the procedure. A colonoscopy searches the whole length of the colon, whereas a sigmoidoscopy only looks at the one third nearest the rectum, so if the latter finds anything it is normally followed by a full colonoscopy to look at the unexamined areas.

In the double contrast barium enema test, barium sulfate (a liquid that looks and feels like watery chalk) and air is introduced into the colon via a catheter. X-rays are then taken to see what shape the barium, which is opaque to X-ray, takes and if there are any polyps or cancerous growths. If these are found, then a colonoscopy is usually recommended to confirm the diagnosis.

CT colonography involves taking CT (computed tomography) images (the patient goes into a large circular machine) of the colon while it is filled with air. If this finds polyps or cancerous growths it is usually followed by a colonoscopy to make sure.

The guidelines also specify three types of stool test that look for cancer, rather than polyps. These are:

1. Guaiac-based fecal occult blood testing (gFOBT; recommended every year).
2. Fecal immunochemical test (FIT; every year).
3. Stool DNA (frequency not specified).

The first two tests, gFOBT and FIT, look for blood in the stool, which can indicate cancer or it could be a large polyp that has started bleeding.

The third test, stool DNA, is quite new. It looks at the DNA of cells shed via the stool to see if any known DNA signatures of cancer are present. It's still a new technique and there is not enough information on how frequently the test should be carried out. The ACS warns that it may not pick up all DNA cancer signatures.

Again, a positive result in any of these three tests would normally be followed up with a colonoscopy.

For the first time, the guidelines also deal with quality of tests. Brooks explained this was necessary because there was a "fair amount of testing going on in the marketplace that is of such poor quality that in many ways you're doing patients a disservice".

One example is the FOBT test. If this shows a positive or suspicious result, good practice recommends the patient is referred for a colonoscopy, but this sometimes does not happen. Brooks said that is a "mistake", and carries the risk that "cancers are going to be missed". Hence the guidelines "go to great lengths to spell out the quality issues that need to be in place for any type of test," he explained.

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Urinary Catheterization

Urinary or Urethral catheterization is a process in which a urinary catheter (such as a Foley catheter) is either inserted through a female patient's urinary tract into their bladder or attached to a male patient's penis. A balloon located at the end of the catheter is usually inflated with sterile water to prevent the catheter from slipping out. In this manner, the patient's urine is collected and contained for various medical purposes. The procedure of catheterization will usually be done by a clinician, often a nurse, although self-catheterization is possible as well.

Urinary catheterization is a routine medical procedure that has both diagnostic and therapeutic purposes.

Types of Catheterization

Catheters come in a large variety of sizes; materials (latex, silicone, PVC, or Teflon); and types (Foley catheter, straight catheter, or coude tip catheter). In the case of internal catheters, those inserted into the urethra, the smallest size is usually recommended, although a larger size is sometimes needed to control leakage of urine around the catheter. A large size can also become necessary when the urine is thick, bloody or contains large amounts of sediment. Larger internal catheters, however, are more likely to cause damage to the urethra. Some people have developed allergies or sensitivities to latex after long-term latex catheter use. In such cases, silicone or Teflon types should be used.

Proper catheter use can also often be determined by the length of time for which the process is necessary: long-term (often called indwelling) or short-term use.

Sex Differences

In males, the catheter tube is inserted into the urinary tract through the penis. A condom catheter can also be used. In females, the catheter is inserted into the urethral meatus, after a cleansing using povidone-iodine. The procedure can be complicated in females due to varying layouts of the genitalia (due to age, obesity, Female genital cutting, childbirth, or other factors), but a good clinician should rely on anatomical landmarks and patience when dealing with such a patient.

Indication

Diagnostic

o Collection of uncontaminated urine specimen
o Monitoring of urine output
o Imaging of the urinary tract

Therapeutic

o Acute urinary retention (eg, benign prostatic hypertrophy, blood clots)
o Chronic obstruction that causes hydronephrosis
o Initiation of continuous bladder irrigation
o Intermittent decompression for neurogenic bladder
o Hygienic care of bedridden patients

Contraindication

Urinary catheterization is contraindicated in the presence of traumatic injury to the lower urinary tract (eg, urethral tear). This condition may be suspected in male patients with a pelvic or straddle-type injury. Signs that increase suspicion for injury are a high-riding or boggy prostate, perineal hematoma, or blood at the meatus. When any of these findings are present in the setting of concerning trauma, a retrograde urethrogram should be performed to rule out a urethral tear prior to placing a catheter into the bladder.

Anesthesia

Topical anesthesia is administered with lidocaine gel 2%. Many facilities have a preloaded syringe with an opening appropriate for insertion into the meatus available either separately or in the catheter kit. To instill, hold the penis firmly and extended, place the tip of the syringe in the meatus, and apply gentle but continuous pressure on the plunger.

Equipment

Commercial single-use urethral catheterization tray

o Povidone iodine
o Sterile cotton balls
o Water-soluble lubrication gel
o Sterile drapes
o Sterile gloves
o Urethral catheter
o Prefilled 10-mL saline syringe
o Urinometer connected to a collection bag

Sterile anesthetic lubricant (eg, lidocaine gel 2%) with a blunt tip urethral applicator or a plastic syringe (5-10 mL)

Positioning

Place the patient supine, in the frogleg position, with knees flexed.

Technique

· Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative.

· Position the patient supine, in bed, and uncover the genitalia.

· Open the catheter tray and place it on the gurney in between the patient's legs; use the sterile package as an extended sterile field. Open the iodine/chlorhexidine preparatory solution and pour it onto the sterile cotton balls. Open a sterile lidocaine 2% lubricant with applicator or a 10-mL syringe and sterile 2% lidocaine gel and place them on the sterile field.

· Wear sterile gloves and use the nondominant hand to hold the penis and retract the foreskin (if present). This hand is the nonsterile hand and holds the penis throughout the procedure.

· Use the sterile hand and sterile forceps to prep the urethra and glans in circular motions with at least 3 different cotton balls. Use the sterile drapes that are provided with the catheter tray to create a sterile field around the penis.

· Using a syringe with no needle, instill 5-10 mL of lidocaine gel 2% into the urethra. Place a finger on the meatus to help prevent spillage of the anesthetic lubricant. Allow 2-3 minutes before proceeding with the urethral catheterization.

· Hold the catheter with the sterile hand or leave it in the sterile field to remove the cover. Apply a generous amount of the nonanesthetic lubricant that is provided with the catheter tray to the catheter.

· While holding the penis at approximately 90º to the gurney and stretching it upward to straighten out the penile urethra, slowly and gently introduce the catheter into the urethra. Continue to advance the catheter until the proximal Y-shaped ports are at the meatus.

· Wait for urine to drain from the larger port to ensure that the distal end of the catheter is in the urethra. The lubricant jelly–filled distal catheter openings may delay urine return. If no spontaneous return of urine occurs, try attaching a 60-mL syringe to aspirate urine. If urine return is still not visible, withdraw the catheter and reattempt the procedure (preferably after using ultrasonography to verify the presence of urine in the bladder).

· After visualization of urine return (and while the proximal ports are at the level of the meatus), inflate the distal balloon by injecting 5-10 mL of 0.9% NaCl (normal saline) through the cuff inflation port. Inflation of the balloon inside the urethra results in severe pain, gross hematuria, and, possibly, urethral tear.

· Gently withdraw the catheter from the urethra until resistance is met. Secure the catheter to the patient's thigh with a wide tape. Creating a gutter to elevate the catheter from the thigh may increase the patient's comfort. If the patient is uncircumcised, make sure to reduce the foreskin, as failure to do so can cause paraphimosis.

Pearls

Insertion of a Coudé catheter: The Coudé catheter, which has a stiffer and pointed tip, was designed to overcome urethral obstruction that a more flexible catheter cannot negotiate (eg, patients with benign prostatic hypertrophy). To place a Coudé catheter, follow the procedure described above. The elbow on the tip of the catheter should face anteriorly to allow the small rounded ball on the tip of the catheter to negotiate the urogenital diaphragm.

Perineal pressure assistance: The distal tip of the catheter might become caught in the posterior fold between the urethra and the urogenital diaphragm. An assistant can apply upward pressure to the perineum while the catheter is advanced to direct the catheter tip upward through the urogenital diaphragm.

Complications

-Infections

o Urethritis
o Cystitis
o Pyelonephritis
o Transient bacteremia

-Paraphimosis, caused by failure to reduce the foreskin after catheterization

-Creation of false passages

-Urethral strictures

-Urethral perforation

-Bleeding

Open Section

* Prophylactic antibiotics are recommended for patients with prosthetic heart valves, artificial urethral sphincters, or penile implants.

* Catheter types and sizes

o Adults: Foley (16-18 F)
o Adults with obstruction at the prostate: Coudé (18 F)
o Children: Foley (5-12 F)
o Infants younger than 6 months: Feeding tube (5 F) with tape

Reference

http://www.emedicine.com
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http://www.wikipedia.org
Served as Secondary source.

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Black Tea may help fight Type 2 Diabetes

Scientists in Scotland have unexpectedly discovered that black tea may help to combat type 2 diabetes. The discovery is at the laboratory stage and the research team is hoping to get funding to investigate further and replicate their findings in clinical settings.

The discovery is the work of Dr. Graham Rena and his team at the Neurosciences Institute of the University of Dundee, and is published in the journal Aging Cell.

Although green tea has for some time been regarded as a health giving food, not many have thought the same about black tea.

Rena and colleagues are researching compounds that have the potential to replace insulin in type 2 diabetes, the type of diabetes where the body's cells have become resistant to insulin, an essential regulator of blood sugar.

Working with fellow researchers from the Scottish Crop Research Institute, Rena and his team found that the black tea compounds theaflavins and thearubigins behaved like insulin.

Rena explained:

"What we have found is that these constituents can mimic insulin action on proteins known as FOXOs."

FOXOs (short for forkhead transcription factor family O) are known to regulate links between diet and health in many organisms, including mice, worms and fruit flies, said Rena. He said:

"The task now is to see whether we can translate these findings into something useful for human health."

Rena pointed out that the Dundee study is just the first step, and if they can find substances that restore the regulation of the FOXO proteins in people with type 2 diabetes, then these could be used to help them overcome some of the serious health problems that this diagnosis brings.

Rena warned that people should not rush out and start drinking lots of black tea in the hope that it will cure their diabetes. A lot more research is needed:

"We are still some way from this leading to new treatments or dietary advice. Our research into tea compounds is at a preclinical, experimental stage and people with diabetes should continue to take their medicines as directed by their doctor," said Rena.

But, he said there is definitely something worth exploring in these natural substances in black tea, and they may have health giving benefits, not just to people with diabetes, he added.

Rena is hoping to get further funding to enable his team to look more closely into how the tea compounds behave like insulin, and also to discover if the effects shown in the laboratory can be replicated in clinical settings.

Diabetes is the fastest growing epidemic in the world.

More than 350 million people worldwide will have the disease by 2030, according to World Health Organization (WHO) estimates.

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Discovery of 'Rain-Making' Bacteria could have Implications for Climate

Brent Christner, LSU professor of biological sciences, in partnership with colleagues in Montana and France, recently found evidence that rain-making bacteria are widely distributed in the atmosphere. These biological particles could factor heavily into the precipitation cycle, affecting climate, agricultural productivity and even global warming. Christner and his colleagues will publish their results in the prestigious journal Science on Feb. 29.

Christner's team examined precipitation from global locations and demonstrated that the most active ice nuclei - a substrate that enhances the formation of ice - are biological in origin. This is important because the formation of ice in clouds is required for snow and most rainfall. Dust and soot particles can serve as ice nuclei, but biological ice nuclei are capable of catalyzing freezing at much warmer temperatures. If present in clouds, biological ice nuclei may affect the processes that trigger precipitation.

The concept of rain-making bacteria isn't far-fetched. Cloud seeding with silver iodide or dry ice has been done for more than 60 years. Many ski resorts use a commercially available freeze-dried preparation of ice-nucleating bacteria to make snow when the temperature is just a few degrees below freezing.

"My colleague David Sands from Montana State University proposed the concept of 'bioprecipitation' over 25 years ago and few scientists took it seriously, but evidence is beginning to accumulate that supports this idea," said Christner.

But, what makes this research more complicated is that most known ice-nucleating bacteria are plant pathogens. These pathogens, which are basically germs, can cause freezing injury in plants, resulting in devastating economic effects on agricultural crop yields.

"As is often the case with bacterial pathogens, other phases of their life cycle are frequently ignored because of the focused interest in their role in plant or animal health," said Christner. "Transport through the atmosphere is a very efficient dissemination strategy, so the ability of a pathogen to affect its precipitation from the atmosphere would be advantageous in finding new hosts."

It is possible that the atmosphere represents one facet of the infection cycle, whereby the bacteria infects a plant, multiplies, is aerosolized into the atmosphere and then delivered to a new plant through atmospheric precipitation.

"The role that biological particles play in atmospheric processes has been largely overlooked. However, we have found biological ice nuclei in precipitation samples from Antarctica to Louisiana - they're ubiquitous. Our results provide an impetus for atmospheric scientists to start thinking about the role these particles play in precipitation," said Christner. "This work is truly multi-disciplinary, bridging the disciplines of ecology, microbiology, plant pathology and climatology. It represents a completely new avenue of research and clearly demonstrates that we are just beginning to understand the intricate interplay between the planet's climate and biosphere."

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Urinary Catheterization (Male)

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Description: Male Urinary Catheterization.
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Urinary catheterization may be performed as either a therapeutic or a diagnostic procedure. Therapeutically, catheters may be placed to decompress the bladder in patients with acute or chronic urinary retention. In addition, catheters may be placed to facilitate bladder irrigation in patients with gross hematuria. Diagnostically, urinary catheters may be placed to obtain an uncontaminated urine sample for microbiologic testing, to measure urinary output in critically ill patients or during surgical procedures, or to measure post-void residuals.