Tuesday, March 19, 2013
Covering Medical Studies: How Not to Get It Wrong
Blogger's Note: this online slideshow presentation may be helpful to others not just journalists, from recent conference
Slideshow
Prevalence of potential drug-drug interactions in cancer patients treated with oral anticancer drugs
Access
" The drug classes most frequently involved in a major PDDI were coumarins and opioids."
Conclusion:
Potential drug–drug
interactions are very common among cancer patients on oral cancer
therapy. Physicians and pharmacists should be more aware of these
potential interactions.
A first-in-class, first-in-human, phase I trial of p28, a non-HDM2-mediated peptide inhibitor of p53 ubiquitination in patients with advanced solid tumours
Access
Conclusion:
p28 was tolerated with no
significant adverse events. An MTD was not reached. Evidence of
anti-tumour activity indicates a highly favourable therapeutic index and
demonstrates proof of concept for this new class of non-HDM2-mediated
peptide inhibitors of p53 ubiquitination.
Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts
Access
Conclusion:
Early
operable primary breast cancer in older women appears as a distinct
biological entity, with existence of a novel cluster. Overall older
women showed less aggressive tumour biology and ER appeared as an
independent prognostic factor alongside the time-dependent axillary
stage. These biological characteristics may explain the differences in
clinical outcome and should be considered in making therapeutic
decisions.
A randomised double-blind placebo-controlled phase II study of AGI004 for control of chemotherapy-induced diarrhoea
Access : A randomised double-blind placebo-controlled phase II study of AGI004 for control of chemotherapy-induced diarrhoea : British Journal of Cancer
Conclusion:
AGI004 demonstrated
effectiveness in reducing chemotherapy-associated diarrhoea, with
results suggesting response across multiple measurements of diarrhoea.
Treatment was well tolerated with no drug-related adverse events.
Further evaluation of this agent in the management of CID is warranted.
Medprep Consulting Inc. Announces Voluntary Nationwide Recall Of All Lots Of All Compounded Products Due To Potential Mold Contamination
Recalls, Market Withdrawals, & Safety Alerts > Medprep Consulting Inc. Announces Voluntary Nationwide Recall Of All Lots Of All Compounded Products Due To Potential Mold Contamination
FOR IMMEDIATE RELEASE – March 17, 2013 –
Tinton Falls, NJ., Med Prep Consulting, Inc. is voluntarily recalling
all lots of all products compounded at its facility. The level of
recall is to the user, that is, regional hospital pharmacies and related
departments, and physician’s office practices. The recall resulted
from the pharmacy being notified by a Connecticut hospital, that it
observed visible particulate contaminants in 50 ml bags of MAGNESIUM SULFATE 2GM IN DEXTROSE 5% IN WATER, 50ML FOR INJECTION
intravenous solution confirmed to be mold. These were unique and
distinct lots compounded and dispensed by the pharmacy to the
Connecticut hospital. At this time a total of five (5) contaminated
bags were discovered. In an abundance of caution, the pharmacy included
all compounded products in the voluntary recall due to lack of
sterility assurance.
Administration of an
intravenous product found to be contaminated with mold, could result in a
fatal infection in a broad array of patients. To date, no injuries or
illnesses have been reported...........
Med Prep Consulting Product List
- Acetylcystiene vials
- Alteplase syringe
- Atropine syringe
- Avastin syringe
- Aztreonam syringe
- Bacitracin vials
- Bupivacaine Bag
- Bupivacaine Syringe
- Bupivacaine OnQ Pump
- Calcium Gluconate Bag
- Calcium Gluconate syringe
- Cefazolin syringe
- Cefazolin Bag
- Cefepime syringe
- Cefepime Bag
- Cefotaxime syringe
- Cefotetan syringe
- Cefoxitin syringe
- Ceftazidime syringe
- Ceftazidime Bag
- Ceftriaxone syringe
- Ceftriaxone Bag
- Cefuroxime syringe
- Cefuroxime Bag
- Clindamycin syringe
- Darboepoetin (Aranesp) syringe
- Dexamethasone Bag
- Diltiazem Bag
- Dobutamine Bag
- Dobutamine syringe
- Ephedrine syringes
- Epinephrine Bag
- Epinephrine Bag
- Epinephrine syringe
- Epoetin Alfa syringe
- Esmolol syringes
- Famotidine syringe
- Fentanyl Citrate Bag
- Fentanyl Citrate with Bupivacaine HCL Bag
- Gentamicin syringe
- Gentamicin Bag
- Glycopyrrolate syringes
- Granisetron syringe
- Hectoral syringe
- Heparin syringe
- Heparin bag
- Hydromorphone syringe
- Hydromorphone Bag
- Hydromorphone PCA syringe
- LET Gel syringe
- LET Soln syringe
- Leukine syringe
- Magnesium Sulfate bag
- Meperidine Bag
- Midazolam Bag
- Midazolam syringe
- Morphine Sulfate Bag
- Morphine Sulfate syringe
- Norepinephrine bag
- Norepinephrine Syringe
- Ondansetron Bag
- Ondansetron syringe
- Oxacillin syringe
- Oxacillin Bag
- Oxytocin bag
- Palanosetron (Aloxi) syringe
- Penicillin syringe
- Penicillin Bag
- Phenylephrine Bags
- Phenylephrine syringes
- Potassium Chloride Bag
- Potassium Phosphate l bag
- Ranitidine syringe
- Rituxan syringe
- Ropivacaine Bag
- Ropivacaine OnQ Pump
- Sodium Citrate syringe
- Sodium Phosphate bag
- Succinylcholine syringes
- Sufentanil with Bupivacaine Bag
- Timentin syringe
- Tobramycin syringe
- Zometa syringe
Monday, March 18, 2013
Placebo: the lie that comes true?
Abstract -- Journal of Medical Ethics
Over the decades of
experimentation on the placebo effect, it has become clear that it is
driven largely by expectation, and
that strong expectations of efficacy
are more likely to give rise to the experience of benefit. No wonder the
placebo effect
has come to resemble a self-fulfilling
prophecy. However, this resemblance is considerably exaggerated. The
placebo effect
does not work as strongly as it is
advertised to do in some efforts to elicit it. Half-truths about the
placebo effect are
now in circulation, reinforced by a
number of other equivocations that it seems to attract. As the deceptive
use of placebos
has fallen into discredit, the use of
half-truths and exaggerations—neither of which is technically a
deception—becomes an
ever more inviting possibility.
However, there are risks and costs associated with the half-truth that
the doctor possesses
the power to make his or her words come
true by the alchemy of the placebo effect.
The prognostic value of estrogen receptor beta and proline-, glutamic acid- and leucine-rich protein 1 (PELP1) expression in ovarian cancer
open access
Conclusion
Positive immunohistochemical staining for the ER coregulator PELP1, alone and in combination
with ERbeta, might be of prognostic relevance in EOC.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Ovarian Surface Epithelial Neoplasms in the Pediatric Popula... : The American Journal of Surgical Pathology
Abstract
Surface epithelial neoplasms account for a small but
significant proportion of pediatric ovarian tumors. The overall
incidence, prevalence of histologic subtypes, and natural history of
these neoplasms has not been thoroughly evaluated. A retrospective
review of the pathology archives of Stanford University School of
Medicine yielded 69 surface epithelial ovarian tumors in 64 pediatric
patients 18 years of age or younger from 1974 to 2010. Tumors comprised
benign (57.8%), borderline/low malignant potential (LMP) (37.5%), and
malignant (4.7%) subgroups and exhibited serous, mucinous, and mixed
histology; there were no clear cell, pure endometrioid, or transitional
(Brenner) tumors. In addition, no high-grade carcinomas were identified.
Clinical follow-up data were available in a subset of patients (maximum
follow-up, 22 y). Similar numbers of recurrences were found in each of
the 3 subgroups. However, overall survival was 100% for benign and
borderline/LMP tumors and 50% for carcinomas. The type of surgical
management and the use of chemotherapy varied; 2 patients with
borderline/LMP tumors were treated by sterilizing procedures and/or
chemotherapy. These data suggest that surface epithelial neoplasms
comprise a small but significant proportion of ovarian tumors in the
pediatric population, and they exhibit a marked preponderance for
benign, borderline, and low-grade malignant subgroups. In contrast to
their adult counterpart, high-grade serous carcinoma in children is
extraordinarily rare and not seen in this series. Given this difference,
uniform treatment modalities with consideration for ovarian
conservation and fertility preservation should be rigorously adopted in
any pediatric patient with a suspected ovarian surface epithelial
neoplasm.
Preoperative clinical and radiological features of metastatic ovarian tumors - Online First - Springer
Abstract
Purpose
To investigate the clinical characteristics and pre-operative imaging features of non-genital metastatic ovarian tumors.
Methods
A retrospective case
series study that compared 18 patients with histologically confirmed
non-genital metastatic ovarian tumors (the study group) with 25 patients
who were diagnosed with a primary ovarian cancer (control group).
Results
The most common primary disease was breast cancer (n = 10;
55 %), followed by colon cancer, gastric cancer, lymphoma, and unknown
primary malignancy. The diagnosis of the previous primary neoplasm
preceded the ovarian tumor diagnosis by 1–20 years (mean 7 years). No
differences were found in the presenting signs and symptoms between the
two groups. Statistically significant differences were noted between the
two groups in the composition of the adnexal mass on sonography (p < 0.0005) and the CA-125 levels (p = 0.007).
The presence of a complex adnexal mass with papillary projections and
CA-125 >170 U/ml predicted primary ovarian cancer in 95.7 % of
patients. Pre-operative CT scan revealed a greater tendency toward
omental involvement and ascites in the control group (p = 0.058).
The median risk of malignancy index (RMI) 2 score was significantly
higher in the control group compared to the study group (8,000 and 1,120
respectively, p = 0.001). Using a RMI 2
cut-off level of 3,800 for diagnosing primary ovarian cancer versus
metastatic ovarian cancer, the sensitivity was 70 %, with a positive
predictive value of 87.5 %.
Conclusion
Pre-operative
sonography findings, CA-125 levels and RMI 2 scores can be highly
accurate in differentiating between primary and metastatic ovarian
tumors.
Sunday, March 17, 2013
Histologic evaluation of prophylactic hysterectomy and oophorectomy in lynch syndrome
Abstract
Abstract
Women with Lynch
syndrome (LS) are at increased risk for endometrial (EC) and ovarian
carcinoma (OC). Current surveillance recommendations for detection of EC
and OC in LS patients are not effective. Small studies have shown that
prophylactic hysterectomy and bilateral salpingo-oophorectomy (P-TH-BSO)
are the most effective and least expensive preventive measures in these
patients. Data regarding histologic findings in prophylactic specimens
in these patients are lacking. All LS patients who underwent P-TH-BSO at
the Memorial Sloan-Kettering Cancer Center from 2000 to 2011 were
identified. Slides were evaluated for the presence of endometrial
hyperplasia (EH), EC, OC, or any other recurrent histologic findings.
Twenty-five patients were identified, with an age range of 36 to 61
years. Fifteen patients had a synchronous or prior colorectal carcinoma,
and 2 patients had a history of sebaceous carcinoma. Focal FIGO grade 1
endometrioid ECs were detected in 2 patients; 1 was 54 years of age (MSH2
mutation; superficially invasive), and the other was 56 years of age
(MLH1 mutation; noninvasive). Focal complex atypical hyperplasia,
unassociated with carcinoma, was seen in 3 patients, ages 35 and 45
(MLH1 mutations) and 53 years (MSH2 mutation). One patient (44 y, with MSH2
mutation) was found to have a mixed endometrioid/clear cell OC and
simple EH without atypia. The OC was adherent to the colon but did not
show distant metastasis. In our study, P-TH-BSOs performed because of
the presence of LS revealed incidental EC and/or EH in 24% of cases and
OC in 4%. The ECs were low grade, confined to the endometrium, and seen
in patients older than 50 years. Prophylactic hysterectomy allows
detection of early lesions in LS; these lesions appear to be small and
focal. This small series of prophylactic hysterectomies may provide some
clues about LS-associated endometrial carcinogenesis. (ovarian cancer??)
HospitalInspections.org | Association of Health Care Journalists
website
Clicking on a state on the map will retrieve a list of all hospitals with their violations grouped together; choosing a state from the drop down menu will list all inspection reports separately, so a hospital may appear more than once.
Saturday, March 16, 2013
Clostridial abdominal gas gangrene masquerading as... [Infection. 2013] - PubMed - NCBI
1) Wiki
2) Medline
~~~~~~~~~~~~~
Abstract
Infection. 2013 Mar 15. [Epub ahead of print]
The
coexistence of clostridial gas gangrene and a gynecologic malignancy is
extremely rare, with very few cases involving ovarian cancer. A patient
originally presented to our gynecologic oncology service with stage IV
ovarian cancer; she underwent a diagnostic laparoscopy and neoadjuvant
chemotherapy. On postoperative day 6, the patient developed severe
abdominal pain, nausea, and emesis, suggestive of a bowel perforation.
2013 open access: Guidelines on Urothelial Carcinomas of the Upper Urinary Tract (LynchSyndrome)
Blogger's Note: UTUC = ureter, kidney, renal pelvis
"The major function of the renal pelvis is to act as a funnel for urine flowing to the ureter.
The renal pelvis is the location of several kinds of kidney cancer."
~~~~~~~~~~~~~~~
European Association of Urology 2013
3.1 Epidemiology
Urothelial carcinomas are the fourth most common tumours after prostate (or breast), lung and colorectal cancer (4,5). They can be located in the lower urinary tract (bladder and urethra) or upper urinary tract
(pyelocaliceal cavities and ureter). Bladder tumours account for 90-95% of urothelial carcinomas and are the most common malignancy of the urinary tract (1,5). However, UTUCs are uncommon and account for
only 5-10% of urothelial carcinomas (4,6). The estimated annual incidence of UTUCs in western countries is about two new cases per 100,000 inhabitants. Pyelocaliceal tumours are about twice as common as ureteral tumours. In 17% of cases, concurrent bladder cancer is present (7). Recurrence of disease in the bladder occurs in 22-47% of UTUC patients (8-10), whereas recurrence in the contralateral upper tract is observed in 2-6% (11,12). The natural history of UTUCs differs from that of bladder cancer: 60% of UTUCs are invasive at
diagnosis compared with only 15-25% of bladder tumours (13,14). UTUCs have a peak incidence in people in their 70s and 80s, and they are three times more prevalent in men than in women (15,16).
There are familial/hereditary cases of UTUCs linked to hereditary non-polyposis colorectal carcinoma (HNPCC) (17). Among patients with UTUCs, HNPCC cases can be screened during a medical interview (18). There is a suspicion of hereditary UTUC if the patient is < 60 years of age, has a personal history of an
HNPCC-associated cancer, a first-degree relative aged < 50 years with HNPCC-associated cancer, or two first-degree relatives with HNPCC-associated cancer (18). These patients should undergo DNA sequencing to identify hereditary cancers that have been misclassified as sporadic cancers by insufficient clinical data (19)......
Promoter Methylation Status and Protein Expression of BRCA2 in Patients with Epithelial Ovarian Cancer
"It has been proven that BRCA1 and BRCA2 methylation are altered in breast cancer. BRCA1 methylation status in ovarian cancer has been
examined, however the BRCA2 gene is under review."
"Based on our results and those of previous studies, it can be concluded that alteration in the methylation of BRCA2 may not be a risk factor
for ovarian cancer development in this studied population, and thus it is not an appropriate biomarker for the early diagnosis of ovarian cancer."
open access: Protecting Patient Privacy and Data Security — NEJM
Protecting Patient Privacy and Data Security — NEJM
"On December 4, 2012, two Australian radio DJs called London's King Edward VII's Hospital, identified themselves, in fake British accents, as Queen Elizabeth and Prince Charles, and asked about a celebrity patient who had been admitted for pregnancy complications. A nurse, filling in at the reception desk in the early morning hours, answered the phone and, without attempting to verify the callers' identities, transferred them to the duty nurse caring for the Duchess of Cambridge. The duty nurse then provided them with confidential patient information.1 The Australian DJs broadcast the phone call, considering it a humorous prank, but as the world knows, it had disastrous consequences.
How confident are U.S. hospitals, nursing homes, and physicians' offices that their staff would appropriately deny patient information to an unknown caller?
Too often, unauthorized people succeed in extracting protected information from health care providers. Invasion of privacy also affects noncelebrities, when anyone seeks health information the patient has not chosen to share. More often, though, scam artists seek patients' billing information for financial gain. The patient's insurance identifier is then used by an uninsured person to obtain medical services or by a fraudulent health care provider to bill for medical services that were never rendered...........
Surgery in elderly people: Preoperative, operative and postoperative care to assist healing
Abstract
Surgery
for elderly women is likely to increase steadily as the population of
elderly people increases globally. Although increasing age increases
perioperative morbidity and mortality, the functional age and
physiologic reserve rather than chronological age is more important in
preventing complications. Preparation for surgery, with special
attention to functional capacity and activity, mental status, and
existing comorbid conditions, can improve outcomes. Perioperative
management must be tailored to physiologic changes of ageing, which
affect respiratory, cardiac and renal function, as well as guidelines
for preventing infection and thrombotic events. Of particular note is
the enhanced effect of narcotic medications in elderly people, which
affects intraoperative and postoperative management of pain. Prevention
of postoperative delirium is accomplished through preoperative and
postoperative planning. Discharge planning, particularly for frail
elderly people, must start before surgery.
Type I to Type II Ovarian Carcinoma Progression: Mutant Trp53 or Pik3ca Confers a More Aggressive Tumor Phenotype (in mice)
Abstract
A
dualistic pathway model of ovarian carcinoma (OvCA) pathogenesis has
been proposed: type I OvCAs are low grade, genetically stable, and
relatively more indolent than type II OvCAs, most of which are
high-grade serous carcinomas. Endometrioid OvCA (EOC) is a prototypical
type I tumor, often harboring mutations that affect the Wnt and
phosphatidylinositol 3-kinase/AKT/mammalian target of rapamycin
signaling pathways. Molecular and histopathologic analyses indicate type
I and II OvCAs share overlapping features, and a subset of EOCs may
undergo type I→type II progression accompanied by acquisition of somatic
TP53 or PIK3CA mutations. We used a murine model (mice) of EOC initiated by conditional inactivation of the Apc and Pten tumor suppressor genes to investigate mutant Trp53 or Pik3ca alleles as key drivers of type I→type II OvCA progression. In the mouse EOC model, the presence of somatic Trp53 or Pik3ca mutations resulted in shortened survival and more widespread metastasis. Activation of mutant Pik3ca alone had no demonstrable effect on the ovarian surface epithelium but resulted in papillary hyperplasia when coupled with Pten inactivation. Our findings indicate that the adverse prognosis associated with TP53 and PIK3CA
mutations in human cancers can be functionally replicated in mouse
models of type I→type II OvCA progression. Moreover, the models should
represent a robust platform for assessment of the contributions of Trp53 or Pik3ca defects in the response of EOCs to conventional and targeted drugs.
Unique Monoclonal Antibody Can Recognize A Cancer-Associated Protein Inside A Cell And Destroy It
media
Unlike other human therapeutic monoclonal antibodies, which can target only proteins that remain on the outside of cancer cells, the new monoclonal antibody, called ESK1, targets a protein that resides on the inside of the cell.
ESK1 is directed at a protein called WT1, which is overexpressed in a range of leukemias and other cancers including myeloma and breast, ovarian, and colorectal cancers. WT1 is a high priority target for cancer drugs because it is an oncogenic protein, meaning that it supports the formation of cancer. In addition, it is found in few healthy cells, so there are less likely to be side effects from drugs that target it.
"This is a new approach for attacking WT1, an important cancer target, with an antibody therapy. This is something that was previously not possible," said David A. Scheinberg, MD, PhD, Chair of the Sloan-Kettering Institute's Molecular Pharmacology and Chemistry Program and an inventor of the antibody. "There has not been a way to make small molecule drugs that can inhibit WT1 function. Our research shows that you can use a monoclonal antibody to recognize a cancer-associated protein inside a cell, and it will destroy the cell."
The first studies of the antibody are showing promise in preclinical research as a treatment for leukemia as reported March 13, 2013, in Science Translational Medicine. .........
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