Squamous cell carcinomas in children and young adults: a new wave of a very rare tumor?

Background

Squamous cell carcinomas (SCCs) seem to have become more common recently. This study aims to check whether the increase is real and to review possible etiologic factors and problems in diagnosis.

Methods

Patients with SCC were identified from anatomical pathology files over 30 years. The number and primary sites seen in the first 15 years were compared with those in the second. Histories were reviewed for predisposing factors. Mucosal tumors were tested for human papillomavirus (HPV) and Epstein-Barr virus by polymerase chain reaction.

Results

One cutaneous SCC and 2 nasopharyngeal carcinomas (NPCs) were seen in the first period, and 2 cutaneous SCCs and 3 nasopharyngeal carcinomas in the second. Another 9 patients with mucosal SCCs were seen in the second period, many with history of cancer treatment or immunosuppression. Two laryngeal SCCs were HPV16-positive. Histologic diagnosis was difficult in 3 patients.

Conclusion

Squamous cell carcinomas have become more common in the last 15 years. Causes include improved survival of cancer patients, therapeutic irradiation, immunosuppression, and possibly, increased prevalence of HPV in the community. Awareness of this increase in children, early biopsy in susceptible patients, repeat wider biopsy, and consultation with adult pathologists may reduce the diagnostic delay.     

Osteoporosis management and the utilization of FRAX?: a survey amongst health care professionals of the Asia-Pacific

Summary

This survey investigated osteoporosis management practices in the Asia-Pacific region. While access to anti-osteoporotic medication is reasonable, screening for secondary contributors is performed insufficiently. FRAX? is well-known, but not used by many physicians. High costs of medication and unawareness about the disease are the biggest barriers to osteoporosis care.

Purpose

Osteoporosis is an increasing burden amongst countries of the Asia-Pacific. The fracture risk assessment tool FRAX? has recently been introduced in some Asian countries. This study aimed to identify attitudes about osteoporosis management in general and the utilization of FRAX? in particular amongst physicians in the Asia-Pacific region.

Methods

A 26-item questionnaire was distributed to the participants of the first Asian regional osteoporosis meeting of the IOF in 2010. In total, 247 valid questionnaires representing 17 countries from the Asia-Pacific region were analyzed.

Results

Most physicians make use of bone densitometry devices (94?%) and have access to at least one type of anti-osteoporotic medication (100?%). Central dual-energy X-ray absorptiometry was the most accessible device (87?%). Oral bisphosphonates were the only medication that was available to health care professionals in all surveyed Asia-Pacific countries. Seventy-six percent were aware of FRAX?; however, among these only 62?% used it. The main reason for not using FRAX? was the lack of country-specific models (46?%). Screening for secondary osteoporosis was performed by 36?% of the respondents. The high costs of medication and lack of awareness amongst physicians and patients about the disease were perceived as the most important barriers to osteoporosis care.

Conclusion

More FRAX? models should be established and implemented into the local guidelines. The necessity of screening for secondary contributors to osteoporosis should be emphasized, as easily treatable causes might be identified. To further improve osteoporosis diagnosis and treatment, the awareness of osteoporosis among doctors as well as patients needs to be raised.     

Interprofessional cooperation, a new mode of regulation?

The "Hospital, patients, health and territories" law marks a paradigm shift in the establishing of the regulatory framework of healthcare professionals' practice in France. From the current situation of national homogeneity, an evolution towards the emergence of regional regulatory frameworks could take place.     

Medicine,Gabriel García Márquez,and Love in the Time of Cholera

The Nobel award-winning author Gabriel García Márquez (born 1927) originally released his book Love in the Time of Cholera in Colombia in 1985. For us physicians and surgeons this book contains lessons about medical humanities and the opportunity to apply them to our profession. Dr. Juvenal Urbino, one of the book's central figures, is a distinguished physician with impeccable training in Paris in the late 1870s to early 1880s. He returned to his native Colombian Caribbean coast to practice medicine and surgery. There his practice set an example for contemporary and future generations of physicians. Urbino was knowledgeable, dedicated, committed, studious, and well-intentioned. He mastered the humanities to the benefit of patients and society alike. He was an outstanding professor at the medical school and a favorite teacher to his attentive students. For all his good virtues, however, he did not serve the poor as much as he should have, possibly as a consequence of his opulent origin in the District of the Viceroys of his natal city. In short, Dr. Urbino brought to the medical profession a bright example of responsibility, professionalism, and integrity. Thus, he should be remembered as a physician and professor worthy of imitating in today's practice of medicine.     

Serous cystadenocarcinoma of the pancreas: a new entity?

Microcystic cystadenoma of the pancreas is a well-recognized although rare pathological entity. All previously reported examples of this tumor have been uniformly benign in behavior. In this case report, we present a primary tumor of the pancreas that was histologically indistinguishable from microcystic adenoma, but which behaved in a malignant fashion. Metastases were found in the stomach and liver. We believe that this case represents a new entity, which we have termed "serous cystadenocarcinoma of the pancreas."     

The measurement of exhaled nitric oxide, a new tool in the management of asthma?

A GOOD DIAGNOSTIC TEST FOR ASTHMA: Chronic airway inflammation, main feature of asthma, can be assessed by measuring the exhaled nitric oxide (NO) level. Measurement of NO is standardized, non-invasive and easy to use in both children and adults. Studies have shown that it is a good diagnostic test for asthma when NO is high. However, other conditions or pathologies must be searched for because they may influence the results. ITS PLACE IN TREATMENT: Although exhaled NO helps to characterise the patients with asthma, other studies are required to show that it can help to improve the follow-up of such patients. Nevertheless, this tool has not yet been validated in the daily treatment of asthma and further research is still ongoing.